School-Based Health Centers and the Medical Home Model

January 5, 2015   |  Tags: Blog   |  Tags: School Based Health Centers , FQHC , Pediatrics , Population Health
Rafael Otto, Oregon School-Based Health Alliance

School-based health centers (SBHCs) in Oregon deliver quality, affordable, cost-effective health care to young people by functioning like a doctor's office on school grounds. They offer a range of medical and health services, enjoy broad community support, help keep kids healthier and in school, and serve as crucial access points for Oregon’s school aged population.

With 68 state-certified centers across the state, SBHCs serve more than 23,000 students annually with an average of three visits per student. Thirty-three SBHCs have attained Patient-Centered Primary Care Home (PCPCH) status, and both the Oregon School-Based Health Alliance and the Oregon Health Authority recognize the value of the PCPCH model for SBHCs and support state-certified SBHCs in achieving PCPCH recognition.

Additionally, 50 SBHCs currently operate as part of a Federally Qualified Health Center (FQHC), and most of them encounter very few barriers to achieving PCPCH recognition. In Multnomah County, for example, all SBHCs have FQHC status and are Tier 2 PCPCH recognized, and the Multnomah County Health Department sees PCPCH recognition as a foundation for improving quality of care and financial stability in SBHCs.

Generally, SBHCs are already well-aligned with PCPCH standards, with a shared mission and intent, including working to integrate primary care with dental and behavioral health care in a way that is truly patient-centered and personal. Though SBHCs are not required to achieve PCPCH recognition, moving toward PCPCH status can help SBHCs demonstrate the highest level of commitment to quality improvement and patient care, better positioning SBHCs as integral partners in regional health care delivery, serving the Medicaid population, engaging with Coordinated Care Organizations, improving business and clinical practices, and building crucial partnerships.

A recent article from Pediatrics: Official Journal of the American Academy of Pediatrics titled “School-Based Health Centers as Patient-Centered Medical Homes,” demonstrated SBHC effectiveness in Colorado. Since Oregon and Colorado SBHCs operate similarly, the study is useful in understanding SBHCs as primary care homes in Oregon. Recognizing that SBHCs are known to increase access to medical care and mental health services for adolescents, the Colorado study demonstrated that SBHCs were largely meeting the service criteria expected of a primary care home. Some examples include:

  • 73% of adolescents and 77 percent of parents reported the SBHC as doing a good or excellent job at “offering lots of different services to meet my/my child’s needs.”
  • 94% of adolescents reported that providers usually or always ensured confidentiality of the visit.
  • 83% of adolescents and 82% of parents reported that the SBHC did an excellent or good job at “respecting my family’s cultural values.”

While many SBHCs are already organized as PCPCHs in Oregon’s health care system, the role of the SBHC still needs clarification to maximize care delivery and coordination. Suggested role definitions currently include, (1) SBHC as primary care provider, (2) SBHC not the designated primary care provider, but providing a majority of care, and (3) SBHC as an ancillary provider.  

SBHC Challenges 

In the Pediatrics article cited above, the research team concluded that “SBHCs appear well-equipped to serve as medical homes…offer access to mental health services for adolescents with unmet needs…and play an important role in the medical community, especially for underserved adolescents.” They also cite challenges for SBHCs serving as medical homes, including a “potential lack of after-hours and summertime support.” These challenges persist in Oregon as well, though they can be mitigated when an SBHC is integrated into a larger community health system, as is the case in Multnomah County where SBHCs operate as part of an FQHC.

Rural and non-FQHC sites are especially challenged by a lack of staff to manage the range of tasks associated with being a PCPCH, including billing activities, documentation, care coordination, and management of advanced technical systems such as electronic health records. Additional barriers to attaining PCPCH status in Oregon include the need for 24-hour telephone support, a lack of patient volume and, regardless of FQHC status, perceived competition with local primary care providers. The most significant challenge in many communities is that SBHCs are unable to refer to specialists or other providers, and that restriction is inhibiting patient care. 

SBHCs are unique PCPCH providers

As more than half of Oregon SBHCs evaluate moving toward PCPCH recognition, SBHCs still struggle with the need to clarify their role in the health care system, communicate their services to students and community partners, and create a child and adolescent-focused service niche. Since it is difficult to uniformly define the level of care and kinds of services across all SBHCs in the state, those challenges need to be addressed at the SBHC level within the context of the local community.

SBHCs also have the ability to provide population-specific care focused on adolescent health, something that community clinics, health departments, and other providers may not be able to provide as easily, comprehensively, or consistently. In this vein, SBHCs can truly focus on serving the youth population and better represent their needs within both the community and health care system, ensuring the needs of youth are well-represented for Coordinated Care Organizations.

Additionally, SBHCs have an excellent track record of serving communities in need and Oregon’s communities of color, with 40 percent of all visits coming from Oregon’s nonwhite populations. SBHCs can actively engage and empower young people to take control of their health care, as well as support youth development and leadership through peer education, advocacy efforts, civic engagement opportunities, youth councils, and leadership activities while working to address social determinants of health such as educational attainment. Youth participation at the SBHC level also improves service delivery, health education and literacy, and the health and academic success of students, further supporting the PCPCH model and the triple aim goals of Oregon’s health care transformation. 

 

Rafael Otto has more than 15 years of experience working in the nonprofit sector in social services, education, development, program design, and communications. He is currently the community affairs director for the Oregon School-Based Health Alliance working at the intersection of health and education for Oregon's K-12 population. Connect with him on Twitter: @RafaelOttoPDX

 

Watch the Institute webinar Enhancing Adolescent Well-Visits, featuring a presentation from the SBHC Clinical Lead Provider from Multnomah County Health Department.