Making the Grade -- Papers

Appendix 2- STATE GUIDELINES FOR SCHOOL-BASED HEALTH CENTERS, 1994
[return to State Initiatives To Support School-Based Health Centers]

	Primary Goal	Sponsoring Agency	Site Specifications	Service Definitions	Staffing	Community Participation	Parental Consent	Continuum of Care	Evaluation & Quality Assurance
C O L O R A D O	To remove financial and organizational barriers that inhibit establishing and sustaining school-based health services which will ultimately facilitate universal access to basic primary preventive physical and mental health care services for the school-age population.	Ideally, SBHCs will be linked with Community Health Centers, local health departments, and county nursing services which are permitted reimbursement without a physician on-site.	Located on the school site.	Varies based on school type: Elementary: well child care; Middle school: well child/ adolescent care, reproductive health, and optional contraceptive services; High school: well adolescent and preventive health services and substance abuse services. All centers offer acute care, lab tests, meds, acute care for chronic conditions, dental care, mental health, and health education	Guidelines suggest school nurse practitioner or physician assistant, mental health practitioner, student health technician (or secretary), and health educator; At the middle and high school levels, substance abuse and violence prevention specialists may be added.	Must provide evidence of relationships with public and private health providers, teachers, school health personnel, community-based organizations, service clubs and other community groups, parents, students, and others determined to have a stake in the health of the community's children.	Parents should be allowed to choose whether their child may use the SBHC services by having the option to sign a consent form.	Case management and follow-up to ensure that all health concerns are adequately addressed; After hours coverage and linkages with all appropriate levels of care is required.	Information on the quantity and quality of services delivered will be collected by sites using School HealthCare On-Line!!; Data and outcome accountability requirements will be defined.
	Source: Making the Grade Application, 1993 and Quarterly Report, 1994.
C O N N E C T I C U T	To expand comprehensive health services for school aged children and adolescents.	A medical provider who delivers services at the community level will be selected by the community advisory board based on ability to meet state agency and RWJ model requirements, willingness to form a partnership with the school system, and ability to meet state licensure standards for an out-patient clinic.	On-site availability of adequate clinic space is mandatory. The SBHC should be located in a fairly visible area of the school. It must be made appealing to the students, both in terms of aesthetics and accessibility. The center must be designed to ensure privacy and confidentiality and meet state licensing standards.	Primary health care, social services, mental health, health education, prenatal and post-partum referral and follow-up; Encourage dental services where need is indicated.	Includes a center manager with training in mental health/health systems management, at least one nurse practitioner with adolescent health experience, one MSW with consultant backup, additional allied health professionals as needed, and clerical support.	Linkages to the community medical and social service providers (local health departments, community health clinics, medical schools/hospitals), must be established and maintained.	Parental consent is required to receive center services	Must define back-up for center non-operating hours and linkage to services beyond clinic scope through letters of agreement. Ideally, the center staff would have privileges at the back-up site(s) in order to enhance the continuity of care.	Both components are site specific and site-determined; Plans and outcomes are monitored by state department of health services.
	Source: Standard Model for School-Based Health Centers, CT Department of Health Services, 1993

STATE GUIDELINES FOR SCHOOL-BASED HEALTH CENTERS, 1994

Primary Goal Sponsoring Agency Site Specifications Service Definitions Staffing Community Participation Parental Consent Continuum of Care Evaluation & Quality Assurance

D

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A
W
A
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E Provide primary prevention and early intervention for health problems among the student population;

Assure that each student has a medical home.
Health care delivery organization;

Local school district and board of education must approve the project's planning and implementation.
Open 5 days a week and operational year round (with provisions for reduced summer hours). All service components will be approved by local school board based on needs of student population;

Services to be provided include medical health assessments, diagnosis and treatment, social services, health and nutrition education, and community service referral;
STD and HIV services may be provided; reproductive health care is prohibited.
Recommended core staff: nurse practitioner, with physician back-up, a minimum of 3 days a week; physician available a minimum of 2 days a week; masters prepared social worker a minimum of 2 days a week; nutritionist a minimum of 1 day a week; clerical support on daily basis; one project coordinator (may be the responsibility of professional staff).

School nurse serves as link between the center and the school.
Local advisory council for both planning and implementation is required. Written parental permission required prior to providing medical services. Plans for provision of services during non-operational hours and reduced hours during summer months must be clearly identified;

Memoranda of understanding required for referrals, support services and 24 hour coverage;

Referral network/ plan between family physician, HMO, or other medical group must be stated.
State public health division serves as manager to assure compliance with accepted model and standards.

Programs are required to participate in School HealthCare On-Line!! data collection system.

Source: Report on School-Based Health Centers in Delaware, Delaware Health and Social Services, December, 1993

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O

U
I
S
I
A
N
A Meet the physical and emotional health needs of adolescents at schools. Shall be private or public institution locally-suited for administration/ operation of SBHC;

(i.e., health center, hospital, medical school, health department, youth serving agency, school or school system);

Non medical agencies must contract medical component with qualified medical provider.
Must function as integral component of school(s) and work cooperatively with school nurses, classroom teachers, coaches, counselors, and school principals;

Local grantees are subject to 20% financial match;

Must become a Medicaid provider.
Should include but not limited to:
preventive health care and medical screenings, treatment for common simple illnesses, referral and follow up for serious illness and emergencies, mental health, alcohol and drug abuse services, immunizations, and preventive services for high-risk behaviors such as pregnancy, STDs, drug and alcohol abuse, violence and injuries.

Should include, at a minimum:

a nurse (or nurse practitioner or physician assistant),
one or more part-time physicians, a social worker or mental health professional at least part-time, and a medical office assistant.

The school nurse should work with the SBHC personnel to develop health education messages.
Must provide evidence of planning process involving a broadly representative community group;

Must form community advisory board.
Must assure parents execute written consent form approved by school authorities. Required to submit plan for monitoring and evaluation

Required to participate in School HealthCare On-Line!! data collection system.

Source: Adolescent School Health Initiative Request for Proposals, 1992

STATE GUIDELINES FOR SCHOOL-BASED HEALTH CENTERS, 1994

Primary Goal Sponsoring
Agency
Site
Specifications
Service Definitions Staffing Community Participation Parental Consent Continuum of Care Evaluation
& Quality Assurance

I

L

L

I

N

O

I

S Improve the overall physical and emotional health of students. May be in or adjacent to a school...

A minimum of two examination rooms is desirable;

State provides specs for clinic equipment and lab utility room.
...devoted primarily to performance of preventive medical, educational, counseling and/or diagnostic procedures;

May include routine medical care, exams, lab screenings, STD and reproductive health services.
Minimum staff shall include a medical director (primary care physician), a registered nurse, a school nurse, and a clerical support person;

May include OB/GYN, ARNP, RN, school counselor, and/or dentist.
Each clinic shall have an advisory board consisting of school administrators, medical community, school nurse, parents, clergy, youth agency reps, community leaders;

Shall have a written plan for community involvement.
Must provide parental consent form including description of the clinic, scope of services offered, and option to select which services are to be provided. To further broaden resources, school-based clinics should link services with other health and social services in their area.

A communication system for emergency and non-emergency services referral shall be available during non-clinic hours.
Internal review team is responsible for continual monitoring of services;

May be performed through random sample of monthly chart audits;

Service standards must meet those of AAP and ACOG.

Source: School Based Health Clinic Guidelines, Illinois Department of Public Health

M

A

I

N

E Establish strong community, school, and parent support and involvement in SBHCs; to assess and evaluate the health care needs of the students; to coordinate delivery of comprehensive primary health care within an educa-tional framework and school setting;
to monitor the health care provided to students; and to evaluate the health status of students by specific outcome criteria.
Eligible sponsor includes school system or medical provider. Must be convenient and centrally located to the students. Space must be adequate in size to provide sufficient room for a waiting area and privacy for physical examina-tions and counsel-ing. Space is
required for laboratory services, equipment, secure storage for supplies, and placement of records. The floor plan should be about 2600 gross square per 4000 school population.
Core services determined by community indicators include physical exams, diagnosis and treatment of minor injuries and illnesses, immunizations, EPSDT screenings, lab tests, chronic illness management; and pediatric care of students' infants. Dental, reproductive and mental health primary care services may be offered but are not required. Recommend nurse practitioner or physician's assistant, physician consultant, a counselor or social worker, and receptionist.

The school nurse should be serve as liaison on the advisory committee and assist in program develop-ment.

Other allied health professionals should be part of the center staff as needed (e.g. nutri-tionist, psychologist, clinic assistant).
A community-based advisory council should include consumer and provider groups, professionals with special skills, community groups with clout, school administration,
school staff, students and others.
Parental consent form must be signed, returned, and on file in order for a student to receive all or indicated center services. Medical consultant or provider group will be available for follow-up services after hours. Participate in School HealthCare On-Line!!

Primary outcome indicators include mental health status, chronic or acute illness, injuries, nutritional problems, pregnancy, drug and alcohol abuse, and tobacco use.

The state conducts site visits and provides instruction-al workshops.
Periodic chart reviews are
conducted to assure adherence to protocols and policies.

Source: Developing a School-Based Health Clinic, An Assistance Manual, ME Department of Human Services, 1992

STATE GUIDELINES FOR SCHOOL-BASED HEALTH CENTERS, 1994

Primary Goal Sponsoring
Agency
Site
Specifications
Service Definitions Staffing Community Participation Parental Consent Continuum of Care Evaluation
& Quality Assurance

M

A

S

S

A

C

H

U

S

E

T

T

S Ensure that children and adolescents will have access to early, comprehensive and competent health care. Joint venture between primary care provider (e.g., community hospital, neighborhood health center) and host school;

Health care provider serves as lead agency;

Must have formal agreement with host school district.
Must demonstrate a floor plan for clinic location;

Must be licensed by state health department;

Must be accessible for outreach and after-school and summer use.
Must offer comprehensive primary care.

Service elements include: screening and assessment, preventive health services, exams, diagnosis and treat-ment, health education, substance abuse services, mental health services, and reproductive health.
Under medical supervision of physician;

On-site staff must include one of the following: physician, nurse practitioner or registered nurse;

Must also include a student health services coordinator to serve as case manager.

The SBHC program is meant to enhance the existing school nursing staff.
Shall establish an advisory committee with student representation. Written parental consent, usually obtained at beginning of school year, is required for all services except those deemed emergency;
Shall include strong referral systems to ensure students receive a continuum of health care;

A linkage plan should be established with clear identification of what will be provided on site and what will be referred;

Must be able to offer 24 hour back-up.
Must participate in statewide SBHC data collection system ;

Must use standardized registration and encounter forms to provide core data set;

State health department conducts periodic site visits to monitor quality.

Source: School Health Services, Request for Proposals, MA Department of Public Health, August, 1993.

N

E

W

Y

O

R

K

Bring direct access to comprehensive primary and preventive health care to medically-underserved children. Provider must be certified under the public health law or be a private and/or group physician licensed to practice medicine in New York;

Must enter into a memorandum of understanding with school, school district or board of education.
Clinics must provide:
mass screening services, physical exams, health and psycho-social counseling, diagnosis and treatment of medical conditions both acute and chronic, immunizations, lab tests, and reproductive health care on site or by referral.
Providers must be mid-level practitioners with physicians as supervisors;

Must meet state DOE requirements for professional licensure and experience;

Additional staff may include social worker, psychologist, and nutritionist.
Parental consent is required unless student is 18 years or older, or otherwise qualified to give consent. Must agree to provide follow-up services for children in need of health care who lack a primary care provider;

Requires linkage with hospital or diagnostic and treatment center for 24 hour, 7 day-a-week continuous comprehensive care.
Required to participate in School HealthCare On-Line!! data collection system;

Required to participate in state-wide quality assurance program, Program Effectiveness Review Tool (PERT).

Source: Requirements for Non-Funded Chapter 53 School Health Demonstration Projects

STATE GUIDELINES FOR SCHOOL-BASED HEALTH CENTERS, 1994

Primary Goal Sponsoring
Agency
Site
Specifications
Service Definitions Staffing Community Participation Parental Consent Continuum of Care Evaluation
& Quality Assurance

N
O
R
T
H

C
A
R
O
L
I
N
A Increase students' access to health care;

Provide early identification of health problems and on-going treatment and prevention of disease and injury;

Encourage students to take personal responsibility for their health care.
In cases where applicant is not a health services institution, a qualified medical provider must be identified to contract for the delivery of medical services;

Letter of commitment from superintendent and board of education required.
Primary site must be located within the school setting and operate full time while school is in session. Must be comprehensive in nature, including primary care, mental health, preventive health care and health risk reduction services.

Must interface with existing health and human services and resources in the school.
Must be provided by a multi-disciplinary team including nurses, physicians, physician extenders, clinical social workers and nutritionists;

At a minimum, on-site staff must include a registered nurse (this may be the school nurse), nurse practitioner/ physician's assistant with physician back up, mental health professional, and clerical staff.
Must be governed in concert with formal community advisory board comprised of parents, community leaders, health care providers, and youth agency representatives for the purpose of planning and oversight;

Must demonstrate high degree of community ownership and support.
Must assure that no student will receive services without a written parental/ guardian consent form on file. Must clearly identify plan for provision of services when the center is not in operation to assure continuity of service delivery and a continuum of care. Must establish criteria for evaluation and measuring success and impact expressed as process and outcome measures;

Required to participate in School HealthCare On-Line!!

Source: Grant Announcement, Request for Proposals, NC Dept. of Environment, Health and Natural Resources, 1994

O

R

E

G

O

N All sites will establish a partnership with the local school district and the local health department;

Other partnerships may include: psychologists, social workers, public and private health care providers, family planning clinics, and hospitals.
On the school campus. A model center will provide accessible, comprehensive, culturally-sensitive services to students, including age-appropriate physical and mental health promotion, prevention, intervention, and treatment services.

Referrals to appropriate sources will be made for services that cannot be provided on-site.
One full-time nurse practitioner or physician's assistant, an MD as medical director and consultant, nurse with adolescent experience, clinical social worker, a drug and alcohol specialist, and a receptionist and/or health assistant.

Other allied health professionals as needed.
Must demonstrate evidence of community input from parents, teachers, students, health care providers, business leaders, managed care and private insurers, and community religious leaders for SBHC planning and implementation

The SBHCs will collaborate with the school district parent-teacher organizations, and the local school site to establish SBHC role within the school system.
Students aged 15 and older can consent to receive health care services and persons of any age can obtain family planning and STD related services without parental consent.

Some local communities have developed enrollment policies that require parental consent for specific services.
Provide integrated services to decrease fragmentation and assure that students receive care and guidance.

At the local level, 24-hour coverage must be provided by a community health care provider/ sponsor.
Chart audits of presenting problems and problem resolution are suggested by the State.

Site visits are conducted by the state through the county health departments every two years.

State Health Division Annual Report is produced annually with data collected by the SBHCs.

Source: Making the Grade Application, 1993.

STATE GUIDELINES FOR SCHOOL-BASED HEALTH CENTERS, 1994

Primary Goal Sponsoring
Agency
Site
Specifications
Service Definitions Staffing Community Participation Parental Consent Continuum of Care Evaluation
& Quality Assurance

P

E

N

N

S

Y

L

V

A

N

I

A Improve the health status of children through the expansion of health services currently available in selected pilot schools and improved integration of school health services within a community-based primary care system. School districts serve as the lead agency in coordination with the community-based primary health care system. On the school site. Must provide a package of primary preventive, child/ family health services including physical assessment, immunizations, growth measurements, developmental and behavioral screening, clinical screens, routine cultures and lab tests, child/family health education services, and referrals for specialty care. Require certified registered nurse practitioner, physician's assistant or physician.

School nurse involvement is encouraged. School nurse may serve as the center manager.
Encourages the involvement of other community-based health and social services providers in program planning and implementation. Require written parental consent for all enrollees. Provide care coordination for follow-up and referrals; assist in accessing needed health, social, nutritional or other services; track referrals to determine service status; conduct home visits when necessary; guarantee assurance of 24-hour on-call services and consultation for referral of problems not treatable on-site. Require collection of encounter and enrollment data to participate in statewide evaluation system;

Assure mechanisms are in place to evaluate the quality and appropriateness of patient care.

Source: Request for Application, School-Based Primary Health Services Pilot Projects, 1992.

T

E

X

A

S

Establish collaboration of families, schools and community;

Assure medical home for student;

Provide access for specialized medical care;

Promote health and use of health systems.

Eligible providers may be civic or charitable organization, community health centers, public health agencies, hospital districts, school districts, medical schools, or private providers;

Full support of school district must be evident.
At a site on or near school grounds. Core services, which must be made available, include: maintenance of health record and health plan, screenings, exams, immunizations, diagnosis and treatment of simple illness and minor injuries, education and counseling, and mental health. May be scheduled full or part-time:
physician/
medical director or an appropriately trained licensed nurse practitioner under physician direction,
mental health counselor;
social worker,
registered nurse, and clerk.

The existing school health personnel and the SBHC staff work as a team.
Advisory council of parents, youth, churches, youth and family services, physicians, nurses, and other health care providers, business, school nurses, school administrators, and faculty to: set policy, identify services, oversee budget, evaluate program; assist in generating community resources. General consent form that identifies all of the services available;

Parent must be offered opportunity to identify specific services that they do not consent to being provided.
Must provide written agreement for provision of after hours and summer care;

Must provide protocol for communicating with child's medical/ health provider;

Must describe mechanisms for exchange of medical, social and financial eligibility information.
Must participate in statewide data collection;

Must provide protocol for physician involvement in record review and consultation.

State health department conducts technical assistance and quality assurance site visits.

Source: School Health Programs Request for Proposals, 1994.

[return to State Initiatives To Support School-Based Health Centers]

	Primary Goal	Sponsoring Agency	Site Specifications	Service Definitions	Staffing	Community Participation	Parental Consent	Continuum of Care	Evaluation & Quality Assurance
D E L A W A R E	Provide primary prevention and early intervention for health problems among the student population; Assure that each student has a medical home.	Health care delivery organization; Local school district and board of education must approve the project's planning and implementation.	Open 5 days a week and operational year round (with provisions for reduced summer hours).	All service components will be approved by local school board based on needs of student population; Services to be provided include medical health assessments, diagnosis and treatment, social services, health and nutrition education, and community service referral; STD and HIV services may be provided; reproductive health care is prohibited.	Recommended core staff: nurse practitioner, with physician back-up, a minimum of 3 days a week; physician available a minimum of 2 days a week; masters prepared social worker a minimum of 2 days a week; nutritionist a minimum of 1 day a week; clerical support on daily basis; one project coordinator (may be the responsibility of professional staff). School nurse serves as link between the center and the school.	Local advisory council for both planning and implementation is required.	Written parental permission required prior to providing medical services.	Plans for provision of services during non-operational hours and reduced hours during summer months must be clearly identified; Memoranda of understanding required for referrals, support services and 24 hour coverage; Referral network/ plan between family physician, HMO, or other medical group must be stated.	State public health division serves as manager to assure compliance with accepted model and standards. Programs are required to participate in School HealthCare On-Line!! data collection system.
	Source: Report on School-Based Health Centers in Delaware, Delaware Health and Social Services, December, 1993
L O U I S I A N A	Meet the physical and emotional health needs of adolescents at schools.	Shall be private or public institution locally-suited for administration/ operation of SBHC; (i.e., health center, hospital, medical school, health department, youth serving agency, school or school system); Non medical agencies must contract medical component with qualified medical provider.	Must function as integral component of school(s) and work cooperatively with school nurses, classroom teachers, coaches, counselors, and school principals; Local grantees are subject to 20% financial match; Must become a Medicaid provider.	Should include but not limited to: preventive health care and medical screenings, treatment for common simple illnesses, referral and follow up for serious illness and emergencies, mental health, alcohol and drug abuse services, immunizations, and preventive services for high-risk behaviors such as pregnancy, STDs, drug and alcohol abuse, violence and injuries.	Should include, at a minimum: a nurse (or nurse practitioner or physician assistant), one or more part-time physicians, a social worker or mental health professional at least part-time, and a medical office assistant. The school nurse should work with the SBHC personnel to develop health education messages.	Must provide evidence of planning process involving a broadly representative community group; Must form community advisory board.	Must assure parents execute written consent form approved by school authorities.		Required to submit plan for monitoring and evaluation Required to participate in School HealthCare On-Line!! data collection system.
	Source: Adolescent School Health Initiative Request for Proposals, 1992