North Carolina State Guidelines

Definition
“School-based health centers are easily accessible and designed to eliminate or diminish barriers to care for students. The school-based health center provides age- appropriate primary health, mental health, prevention and health education services. Most care is provided on-site. Some services, based on local need and expertise, may be made available by referral with appropriate follow-up.”

Service Guidelines

D = directly provided on site; R /AT = referral w/ assurance & tracking mechanism;
L = Link with school or community resources
Services School-Based Health Centers
Medical Care
  • Comprehensive health assessment: (D)
        – History of present illness
        – Past medical history
        – Family history
        – Review of systems
        – Psychosocial screening for health risks (D)
        – Comprehensive physical exams (D)
        – Screenings: vision/hearing/dental/developmental/nut ritional (D)
      – One-on-one education about identified health problems/risks (D)
  • Diagnosis of presenting health problems (including acute and chronic illnesses, minor injuries, pregnancy, and mental health concerns such as depression and substance abuse) (D)
  • Treatment/Management of identified or presenting problems:
        – acute illnesses and injury (D – R/AT)
        – chronic illness (D – R/AT)
        – acute dental (R/AT)
        – prenatal care (D – R/AT)
      – prescriptions (D)
  • Pregnancy options counseling (R/AT)
  • Case management (D)
  • Prescriptions
Preventive Health Services and Risk Management
  • Immunizations (D)
  • Health Check (EPSDT) screening
  • Anticipatory guidance/counseling (including abstinence, self-breast and testicular exam, nutrition, physical fitness, safety, injury, and violence prevention, stress management, etc.) (D)
  • Nutrition counseling and weight management (D)
  • Sexual abstinence counseling (D)
  • Dental care (D-R/AT)
Mental Health Assessment and Treatment for the following: (all D – R/AT)

  • Immediate response to emergency/crisis situations
  • Physical/Sexual abuse prevention/counseling
  • Alcohol/substance abuse prevention/counseling
  • Depression/suicide prevention/counseling (L)
  • Linkage with school and community counseling
  • School performance/behavior problems
  • Short-term counseling
  • Case management
  • Group and family counseling
  • Psychiatric evaluation and treatment
  • Long-term counseling
Laboratory Testing CLIA I tests: (all D)

  • Hematocrit/hemoglobin
  • Urinalysis-dipstix
  • Wet-prep
  • Pregnancy testing
  • Tuberculin skin testing
  • HIV/STD testing
  • Other tests according to GAPS and CLIA II & III guidelines (R/AT)
Reproductive Health Care
  • Age-appropriate reproductive health care and counseling. (R/AT)
Health Education/Promotion
  • One-on-one health education
  • Group/targeted education
  • Family and community health education
  • Health education for health center and school staff
  • Support for comprehensive health education in the classroom in such areas as:
        – Substance use prevention/cessation
        – Intentional and unintentional injury prevention
        – Nutrition (L)
        – Social skills development
        – Death and dying issues
        – Physical and emotional development
        – Conflict resolution
        – Child abuse prevention
        – Violence prevention (L)
        – STD/HIV/AIDS prevention (L)
        – Pregnancy prevention
        – Chronic conditions (i.e. asthma)
        – General parenting skills
        – Chronic disease prevention (smoking cessation/prevention, heart disease, osteoporosis)
        – Dental health
        – Enhancing family/peer relationships
      – Physical fitness (L)
Social Services
  • Assessment and referral to social service agencies to provide the following:
        – Assistance attaining basic needs (food, shelter, clothing)
        – Legal services
        – Referral to Public Assistance
        – Assistance with Medicaid and other health insurance enrollment
        – Employment services
        – Day-care services
        – Transportation
      – Child protective services
Nutrition Services
  • On-site services include:
        – Comprehensive nutritional assessment
        – Weight management counseling
        – Therapeutic diet counseling for chronic disease prevention and treatment
        – Nutrition education and counseling
      – Disordered eating, screening and referral
  • On-site services or referral for the following:
        – Consultation to child nutrition/school food service staff on diet modifications for children with special needs
        – Consultation to coaching staff on sports nutrition
        – Nutrition counseling for faculty and staff
      – WIC Program certification and nutrition education for pregnant and parenting teens
Other Services Provided on-site or by referral:

  • Dental care
  • Specialty care
  • Well-child care of students’ children

Operating Guidelines

Services School-Based Health Centers
Facility Requirements
  • Private examination and treatment room(s) with accessible sinks
  • Private area(s) for counseling, education, and training
  • Laboratory space
  • Waiting and reception area
  • Secure storage area(s) for pharmaceuticals, supplies, and records
  • Adequate clerical area
  • Patient bathroom
  • Accessible to individuals with disabilities
  • Current fire and building safety certificates and electrical/mechanical equipment in safe working order
  • Private telephone line to ensure confidentiality and adequate access to community and back-up providers
Staffing Requirements
  • Comprehensive services must be provided by a multi-disciplinary team of professionals. Recommended staff include a:
        – Registered nurse, – Nurse practitioner/physician assistant,
        – Mental health professional,
        – Health center manager,
        – Nutritionist, and
      – Clerical staff
  • Other staff positions may include:
        – Health Educator
        – Community outreach coordinator
        – Mental health supervisor
      – Dentist or dental hygienist

Physician back-up, as required by state law, must be available for mid-level practitioners.

Health Care Access
  • All centers must operate full-time while school is in session.
  • The center ensures 24-hour access to services for enrolled students.
  • Centers “must have a clearly identified plan for quaranteeing access to health services when the center is not in operation (i.e., evenings, weekends, summer vacation and holiday, etc) to assure continuity of service delivery and a continuum of care.”
  • No student will receive services at the center unless written parental/ guardian consent form, approved by school authorities, is on file. If individual receiving services is 18 years or older or is qualified to give consent under G.S. 90-21.5a and is competent to give such consent, such consent will be obtained.
  • Any student enrolled in the center can access services.
Quality Management and Improvement
  • Center develops and implements a quality management program that monitors and evaluates the appropriateness, effectiveness, and accessibility of the services provided.
  • There are written specified quality assurance policies and procedures for:
        – Provider credentials and maintenance;
        – Professional continuing education;
        – Pre-employment procedures;
        – Staff and program evaluation;
        – Chart review criteria;
        – Selection of clinical issues/investigation;
        – Complaint and incident review;
        – Corrective actions and time frame;
        – Data management/utilization
        – Staff case conferencing; and
      – Fiscal operations.

The center complies with the data collection requirements of the state.


Targeting Guidelines

Targeting Criteria School-Based Health Centers
School and Community Support
  • Must be a high degree of community ownership and support for the development and sustainment of the centers, including commitments made by public schools, the local health department, hospitals, area mental health programs, community, migrant, and rural health centers, private physicians, elected officials and other community leaders, and youth serving agencies.
  • Center must have a formal community advisory board which includes broad community representation, parents, youth and family- serving agencies, and other appropriate organizations.
  • Centers are expected to work cooperatively with resources in the schools and community, such as Student Assistance Programs (SAP’s), Communities in Schools (CIS), school nursing, etc.
  • Capacity to implement:
    1. Community commitment
    2. Availability of integrated provider network and billing capacity
    3. Presence of a state managed care program (Carolina Access/Alternatives)
    4. Presence of a non-profit hospital
    5. Presence of a Healthy Carolinians Planning/Task Force
    6. Experiencing working with this population
Student Need
  • School age children grades (K-12)
  • Uninsured school-age children (6-17) Access to health care:
    1. Health Professional Shortage Area
    2. Medically Underserved Area
  • Services are targeted to the school-age population with a documented need for services and address important health challenges, such as unintentional injuries, violence, too early parenting, alcohol, tobacco and other forms of substance abuse, nutritional problems, and unmet dental needs.
Sustainable Programs
  • Community provides cash or in-kind support.
  • Centers should be in a position to participate in managed care and for billing Medicaid and other third party payers.
  • Size of school population sufficient to generate adequate demand and volume.

Sources

North Carolina Department of Environment, Health, and Natural Resources. Quality Standards For School-Based Health Centers in North Carolina. North Carolina: Division of Maternal and Child Health, March 3, 1997. Draft

North Carolina Department of Environment, Health, and Natural Resources. Request for Proposal: “Making the Grade: State and Local Partnerships to Establish School-Based Health Centers”. North Carolina: Division of Maternal and Child Health, December , 1996.