Quality Guidelines, Standards of Care, & Certification Requirements

State Resources - Massachusetts
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SCHOOL-BASED HEALTH CENTER QUALITY STANDARDS

1.1 The center must operate each day when school is in session at regularly scheduled hours that:

1. are convenient to students and include, as necessary, some before or after school hours;
2. to the maximum extent possible, accommodate working parents/guardians who participate in the care of their child;
3. allow for urgent appointments within the same day;
4. to the maximum extent possible, permit scheduled appointments that do not unnecessarily interrupt the student's classroom time; and
5. are displayed in a public location, and in multiple languages, if appropriate to the student population.

 

1.2 The center must have in place telephone answering methods that notify students and parents/guardians where and how to access 24-hour back-up services when the center is not open.

1.3 The center must provide mental health and substance abuse services, either on-site or through referral arrangements, that offer:

1. immediate response to emergency/crisis situations
2. urgent appointments whenever possible within the same day and no later than three calendar days after the request for service is made; and
3. non-urgent appointments within seven calendar days.

 

1.4 The center, in response to the cultural and language needs of the student body, must ensure that center staff has education in cultural diversity, and that translation services, appropriate to the major school population(s), are provided by staff or interpreters in a manner that ensures confidentiality.

1.5 Enrollment and registration processes must provide for effective collection of information regarding third-party billing resources and the identity of primary care providers. The center may not deny access to care to students without insurance.

1.6 The center must provide services to students in a manner which ensures the student's and his/her family's right to privacy.

B) Physical Plant

1.7 The center, if located in a school that serves handicapped students, must be accessible to individuals with disabilities.

1.8 The center must include adequate waiting and reception areas, office space, private examination and treatment room(s) with sink(s), bathroom(s), secure storage area(s), and utility area(s).

1.9 The center must have current fire and building safety certificates, and electrical/mechanical equipment must be in safe working order.

1.10 The center staff must have the training, supplies and equipment necessary to follow infection control practices (including environmental sanitation, cleaning and sterilization of equipment and supplies and the disposal of hazardous and medical waste, pursuant to 105 CMR 480.000 et seq.). The center must comply with laws and regulations regarding reportable diseases and conditions, pursuant to 105 CMR 300.000 et seq. and must develop and comply with employee health policies.

2.0 PROFESSIONAL QUALIFICATIONS STANDARD: School-based health center services are delivered in accordance with professional standards and by qualified licensed and/or registered staff.

2.2 If the center contracts with an outside agency for the provision of mental health and/or substance abuse services, the contracted agency must have experience in providing care to children and adolescents and be duly licensed, if subject to such licensure.

2.3 The center must ensure that staff participate, at a minimum on an annual basis, in ongoing professional development programs to update and enhance their knowledge of community and school health and health promotion and illness prevention strategies for children and adolescents.

2.4 The center must ensure that staff are assigned responsibilities consistent with their education and experience, supervised, periodically evaluated, and trained in the policies and procedures of the health care provider operating the center.

2.5 Center staff must be currently trained in emergency care, including general first aid, cardiopulmonary resuscitation, and the Heimlich maneuver. The health center must have a written emergency care plan for disasters and for crisis interventions that is consistent with the school's plans and coordinated with the community emergency response system. Staff are trained in implementing the plan.

3.0 ORGANIZATIONAL STRUCTURE STANDARD: The school-based health center operates according to written organizational and clinical protocols that ensure that primary care services are delivered to students in an organized manner.

3.2 The center's organizational structure must include an administrator responsible for the overall management of the health center and for serving as a liaison with the health care provider operating the center, and sufficient support and clerical staff to carry out required administrative functions, including the collection of insurance and billing information.

3.3 To the maximum extent possible, the center must bill third party insurers for covered services.

3.4 The center must have at least one nurse practitioner, physician, or physician assistant on site during all hours of operation.

3.5 School nursing services are sufficient to conduct health screenings and other mandated health services to students at the school served by the center.

3.6 The center must provide each student's care in accordance with written practice guidelines for clinicians. Such guidelines shall be developed in collaboration with the health care provider operating the center.

3.7 Medical services must be provided under the medical direction of one designated physician who has knowledge of community and school health and health promotion and illness prevention strategies for children and adolescents.

3.8 The center must offer a comprehensive range of primary care services. Services provided on-site must include, at a minimum, preventive health care services delivered according to the Division of Medical Assistance's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Medical Protocol and Periodicity Schedule, diagnosis and treatment of acute illness, treatment and follow-up of chronic illness, health education and age appropriate anticipatory guidance to include injury and violence prevention. If not provided on site, the center must arrange for the provision of nutrition services, reproductive health services, sexually transmitted diseases (STD) services and human immunodeficiency virus (HIV) services.

3.9 If the center provides mental health or substance abuse treatment services directly, the services must meet the applicable DPH licensure regulations.

4.0 CONTINUITY OF CARE STANDARD: The school-based health center develops a collaborative relationship with the student, his/her parent or guardian, the school health program, and other health care providers in the child's community.

4.2 The center must operate in accordance with a systematic process for referring students to community-based health care providers (e.g., PCCs, HMOs, MH/SA providers) when the center is not able to provide the services required by the student. The center shall refer a student, enrolled in a managed care plan (PCC or HMO), who requires specialty medical and/or surgical services to his/her PCC or HMO to obtain a referral to a specialist. The center shall document in the student's record that the referral was made, and document follow-up on the outcome of the referral when relevant to the health care provided by the center.

4.3 The center must promote collaboration and the exchange of information related to meeting a student's health needs between the school health staff and relevant school staff and community providers. This collaboration and exchange must be consistent with all applicable confidentiality and consent requirements. School staff and community providers include, but are not limited to:

• the school nurse;
• school administrators;
• teachers;
• specialty school program staff (e.g., bilingual, deaf, special education);
• student support teams; and
• community-based health care providers (e.g., PCCs, HMOs, MH/SA providers, specialists).

 

4.4 Center staff must participate in school efforts, such as health fairs, classroom presentations and special events, to provide comprehensive health education to students.

4.5 The center must obtain consent for treatment. Written protocols must (1) require the written permission of a parent/guardian, except where minors are authorized by law to provide consent (2) incorporate the rights of minors to consent to their own treatment as provided for by law, including consent for testing and treatment for STDs, diagnosis and treatment of substance abuse, and pregnancy testing and (3) establish a timeframe for renewing written permission.

4.6 The center establishes and/or participates in a community advisory committee which assists the center in the integration of services with community resources and advises the center on policy and program matters. The committee will, at a minimum, be comprised of the school nurse, the school physician, students, parents, individuals in the community involved with health issues and education, social services, state and local community representatives. The committee may be integrated with a school-wide health advisory committee.

4.7 The center must develop and distribute to the community written materials and perform other promotional activities that define and promote the goals and services of the center. Such materials must be bilingual, if appropriate to the community.

4.8 The center must prepare students to ultimately assume responsibility for their own health care, including the provision of information about the appropriate use of community resources.

5.0 QUALITY MEASUREMENT STANDARD: The school-based health center develops and implements a quality management program that monitors and evaluates the appropriateness and effectiveness of the services provided.

 

5.2 The school-based health center must comply with data collection requirements of the Department of Public Health and has in place a method to collect and aggregate data on the enrolled student population to include, but not be limited to, rates of student drop-out, absenteeism, substance abuse, pregnancy, infant mortality, and delivery of preventive health care services delivered according to the EPSDT Medical Protocol and Periodicity Schedule.

6.0 MEDICAL RECORDS STANDARD: The health center establishes a record-keeping system that provides for consistency, confidentiality, and security of records in documenting significant student health information and the delivery of health care services.

6.2 The center must implement procedures which ensure that cross-referencing of medical records with the medical record system of the health care provider operating the center is possible at all times.

6.3 If the center is closed during school and summer vacations, the center must transfer student health records to the health care provider operating the center within an established timeframe that ensures continuity of care.

6.4 The center must lock and otherwise maintain records and copies of records in a secure manner that protects them from unauthorized use. Access to records shall be limited to center staff providing care to the student, unless proper consent has been obtained. Center records must be maintained separately from school records.

6.5 The center must ensure that the records contain sufficient information to justify the diagnosis(es) and treatment, and accurately document all health assessments and services provided to the student.

6.6 Each entry into the student's record must be dated and authenticated by the staff member making the entry, indicating name and title.

6.7 The center works in collaboration with the Department of Public Health in its project to computerize student health information.

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