http://smhp.psych.ucla.edu/publications/17%20mental%20health%20in%20schools%20and%20system%20restructuring.pdf

Mental health in schools and system restructuring.

School-based health centers (SBHCs) have proliferated rapidly nation-wide and remain politically popular. This article explores the disconnect between the evidence and the discourse on SBHCs, drawing upon the authors' evaluation of SBHCs in Newark, New Jersey, and a critical assessment of the evaluative literature and public discourse on school clinics to argue that a number of important issues are being overlooked by both research and advocacy. These issues include variations in the health needs and health care resources of different communities and the questions of whether and how SBHCs can best integrate with existing resources to fill unmet local needs. Furthermore, despite the cautions of experts that third-party reimbursement (via traditional fee-for-service insurance or participation in health maintenance organizations) cannot cover clinic expenses and is difficult to obtain, pursuit of reimbursement continues to be a goal of some SBHC sponsors, helping to promote a clinic model that in some communities is very likely not to be the best way to address student needs or to build on clinic strengths. Discussion around SBHCs should focus on diagnosing specific community needs, identifying the best approach to meeting those needs, and seeking funding sources that match the work that needs to be done.

Making the case for school-based health: where do we stand?

Adolescents are often vulnerable to particular health risks and face multiple barriers to accessing health care. School-based clinics and school-linked services represent an alternative model of care that has responded to the unique health issues of adolescents by offering preventive, comprehensive services, including mental health and other sensitive services. The current restructuring of the American health care delivery system presents a serious challenge to the continued existence of these services, which must link successfully with managed care organizations and adapt to significant changes in federal and state funding streams to remain viable. The continued success of school-based health services in improving adolescent health will largely depend on how well they can capitalize on their strategic position to reach adolescents, respond to their health needs, and reduce barriers to care, and how effectively they can integrate themselves into a rapidly evolving US health care delivery system.

School-Based Health Clinics: Remaining Viable in a Changing Health Care Delivery System

Objective. Because of the broad and increasing interest in school health, the American Academy of Pediatrics (AAP) surveyed its members to determine their awareness of school health education/programs, their level of participation, their desire to participate, and their resource needs to participate more effectively. Methods. Self-administered questionnaires were mailed to a randomized representative sample of AAP members ( N = 1602). Overall response rate was 64.5%. Some responses were stratified for analysis by gender; age (>45 years or ≤45 years); practice area (urban, suburban, or rural); practice setting (solo, group, or hospital); and type of practice (general versus specialty). χ 2 Tests were used to compare responses. Results. Greater than half of the pediatricians who responded to the questionnaire were aware of school health education curriculum on risky adolescent behaviors in their community, counseling services (58%), school nursing services (63%), and screening services (71%); however, more than half were not aware of curriculum on injury/violence prevention, fitness, or whether a school health advisory council was available. Most pediatricians supported comprehensive school health education (pregnancy prevention, 82%; violence prevention, 77%; mental health, 56%). Also, respondents supported services (counseling, 76%; nutrition, 65%; screening/referral, 58%; school-based primary care, 58%). Although 22% of AAP pediatricians are currently working with local school programs, >70% wanted to become involved or more involved and needed information on how they may be able to participate. Only 25% believed they were adequately prepared. Two thirds believed school-based clinics were one of the best ways to reach underserved children and adolescents and should include preteens. Conclusion. AAP pediatricians want to become more involved with comprehensive school health programs. The ways in which they want to participate vary substantially. Most pediatricians thought they needed additional education. The AAP has developed recommendations for graduate medical education and continuing medical education for pediatricians to participate in integrated school health services.

https://pediatrics.aappublications.org/content/pediatrics/103/4/e45.full.pdf

Pediatricians' Response to the Demand for School Health Programming

Three areas of school-based health promotion and disease prevention will be described in this chapter, including school-based intervention research, comprehensive school health programs, and school-based health clinics. School-based intervention research is the process of developing and evaluating interventions that are delivered in the schools and designed to modify a specific set of health behaviors. Comprehensive school health programs involve the implementation of eight objectives for school health education. These objectives impact health education curricula, as well as school health policy, staff wellness, and staff training for health education. School-based health clinics involve the delivery of health services and prevention activities directly to children through clinics in the schools.

Schools as a Setting for Health Promotion and Disease Prevention

As school-based health centers have established a track record in providing access to primary care services for underserved school-age populations, financial viability of these programs has become increasingly dependent upon revenues generated from Medicaid and other third-party payers. The introduction of managed care concepts into this situation has created great uncertainty for the future. The authors discuss the various types of managed care models that school-based health centers are being called upon to work with and summarize the key issues (communications, confidentiality, linkages, reimbursement, and quality improvement) around which those relationships are being developed.

C. Brellochs

Papers

School-Based Primary Care in a Managed Care Environment: Options and Issues.