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| www.casbhc.org CASBHC News |
Summer 2009 |
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Congressional Action May Greatly Enhance Sustainability of School-Based Health Centers
The time is now. NASBHC and CASBHC are currently focused on the passage of two bills at the federal level. The first is The Healthy Schools Act of 2009 (S. 1034/H.R. 2840) which was introduced in the Senate in May and the House in June. This legislation will mandate that states have a mechanism in place to reimburse SBHCs for covered services provided to Medicaid and CHP+ patients. Both of Colorado's senators, (Michael Bennet and Mark Udall) have agreed to co-sponsor the Senate version, and Representatives Diana DeGette and Ed Perlmutter are co-sponsoring the House version.
Thus far, NASBHC has thirteen national partners who have signed onto a declaration supporting The Healthy Schools Act, including:
- The Coalition for Community Schools
-National Coalition for Parent Involvement in Education
- Sexuality Information and Education Council of the United States
- Advocates for Youth
- American Federation of Teachers
- National Council of Urban Indian Health
- National Indian Health Board
- National Association of School Psychologists
- National Association of Pupil Services Administrators
- American Counseling Association
- Children's Aid Society
- National Association of Pediatric Nurse Practitioners
- American Lung Association
This is just the beginning and we expect many more.
The second bill we are working on is The School-Based Health Clinic Act of 2009. This legislation amends the Public Health Service Act and authorizes a federal grant program to support SBHCs. Its sponsors are Senators Dodd (D-CT) and Alexander (R-NC) and Representatives Capps (D-CA), Rogers (R-MI), Capito (R-WV), and Davis (D-CA). Because the bill has not yet been introduced, there are no assigned bill numbers.
Although The School-Based Health Clinic Act is moving forward as a stand-alone bill, there are also efforts to include a SBHC grant program as part of the health care reform package. The Senate's legislation on health care reform developed by the Health, Education, Labor, and Pensions (HELP) Committee, led by Senator Edward Kennedy (D-MA), includes language in Section 312 that authorizes a grant program for the operation and development of school-based health clinics. Within hours of releasing the proposed legislation, 121 amendments to Section 312 were submitted, indicating a high level of interest in defining school-based health care within the context of health care reform.
Finally, in addition to the bills directly affecting SBHCs, NASBHC and CASBHC are supporting the Students-to-School Nurse Ratio Improvement Act of 2009 (H.R.2730). This legislation was introduced by Representative Carolyn McCarthy (D-NY) and 12 co-sponsors. Senator McCarthy was a nurse for thirty years prior to being elected to Congress.
CASBHC will keep you updated through this newsletter and action alerts throughout the 111th Congress. If you have any questions or concerns regarding federal legislation, please do not hesitate to call me.
Debbie | |
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Voihce: Successfully Integrating Positive Youth Development in one Colorado SBHC
As the School-Based Health Center (SBHC) and Positive Youth Development (PYD) movements gain momentum in Colorado, new and existing SBHCs are looking for ways to integrate PYD to maximize the effectiveness of their programs. One-on-one relationships between SBHC providers and students already incorporate elements of PYD; providers listen to teens' concerns, work with teens to help them make health decisions and encourage them to take a proactive role in their own health care. Since this type of one-on-one partnership already exists, SBHCs can strengthen their overall service provision by beginning to explore additional ways to engage youth outside of the provider/patient relationship. One way to accomplish this is by establishing a youth advisory board, which regularly allows teens and adults to work together to address health concerns and improve SBHC marketing and service delivery for the entire student population.
Community Health Services (CHS) is a perfect example of how integrating PYD into SBHCs can be beneficial for everyone involved, including prospective patients. Currently, CHS runs 6 SBHCs in Adams 50 and Adams 14 school-districts. In the past, CHS's main clinic has been housed across the street from Adams City High School. With the construction of a new Adams City High School, there was the perfect opportunity to establish another SBHC located within the school. CHS enlisted the help of 12 students from Adams City High, forming their first youth advisory board. The advisory board was charged with developing ways to ensure the entire student population was aware of the new SBHC, would be comfortable using the SBHC, and had a voice in its design and planning.
From the beginning, CHS's youth advisory board was a partnership between the teens involved, Adams City High school, CASBHC and CHS. The teens determined what they wanted to work on, how they wanted to structure their meetings and how they would market their new SBHC. One of their first ideas was to create a unique name for the group. In less than 24 hours they had decided upon the acronym VOIHCE, which stands for "Voicing Our Imperative Health Concerns Everyday". They felt their "voihce" in the new SBHC would give students the opportunity to define and express their health priorities and ensure they were addressed in a youth friendly way that targeted all students.
Over the course of three months, the group held 14 meetings, passed out over 100 teen resource cards, created a logo and T-shirts, and solicited information from over 110 of their peers about teen pregnancy concerns and awareness about the new SBHC. They met with the CHS planning committee and helped brainstorm and trouble shoot issues such as maintaining confidentiality in the new clinic and differentiating between the school nursing services and SBHC services.
When asked to give feedback about their experiences in Voihce, the students reported gaining skills that helped them share ideas with adults, influence programs that are designed for youth, and make more informed decisions about their own health. Some of their comments included "You should know that this was a GREAT idea" and "I just think this is a really great and smart way to get teens involved in the SBHC." Equally important, all members said they had talked to "all" of their friends about Voihce and the new SBHC. If research has told us anything about PYD, we can be assured that teens talking with teens is an excellent way to convey important information about how and where to access health services. The next project on deck: planning and hosting a youth-focused grand opening of the new SBHC.
For more information about integrating Positive Youth Development into your SBHC, contact Melinda Gonzales, Director of Adolescent Health by clicking here. |
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New Funding Available for SBHC Planning
The Colorado Health Foundation's School-Based Health Care Initiative was announced on June 1. This is great news for communities and schools in Colorado that have been discussing the possibility of having a school-based health center available for their students. This state-wide initiative will invest $10.8 million over the next four years. The funding is for planning and implementing new programs.
CASBHC will be working closely with The Colorado Health Foundation on the initiative by providing technical assistance and training to communities. CASBHC staff will be available to:
· Assist communities with the completion of the required Readiness Assessment. The Readiness Assessment, along with an abbreviated School-Based Health Care Initiative application, should be submitted to apply for up to $20,000 for planning.
· Recommend consultants who will be available to communities and schools who have been awarded a planning grant. The centerpiece of the planning process is to develop a multi-year business plan. Each planning community will decide whether to hire a consultant to help complete the business plan.
· Be available to answer questions and provide technical assistance as needed.
The Colorado Health Foundation web-site has all the details of the School-Based Health Care Initiative, along with the readiness assessment, business plan template and abbreviated application. The web-site address is: www.coloradohealth.org/school-based_health_care.aspx.
The Colorado Health Foundation will host webinars periodically to discuss the planning and implementation process as well as answer questions about the School-Based Health Care Initiative. The first will be July 8, 2009 at noon. To register for this webinar, go to cc.readytalk.com/r/abqbbzs51o7j If you have questions about the technical assistance available please contact Betty Pepin, Director of Technical Assistance at pepin@casbhc.org or call 303.399.6380 ext. 105. |
By the Numbers
- Percent of Colorado children under age 18 without health insurance in 2007: 14%
- Percent of U.S. children under age 18 without health insurance in 2007: 11%
- National ranking of Colorado in insuring children in poverty in 2006: 50th
- Percent of Colorado children qualifying for Free or Reduced Lunch in 2007: 35%
- Increase in Colorado school-aged children in poverty from 2006 to 2007: 0.6%
- Number of babies born to Colorado teens aged 10 to 19 years in 2007: 6,754
Source: Colorado Children's Campaign's 2009 KidsCount in Colorado |
Eighth Annual National Day to Prevent Teen Pregnancy
On May 6, 2009, more than 450,000 teens participated nationwide in an online survey to promote the importance of avoiding teen pregnancy and other serious consequences of unprotected sex, an increase from 300,000 in 2008. President Obama, in advocating for the National Campaign for Teen and Unplanned Pregnancy, stated the National Day was necessary in our efforts to "recommit ourselves to raising awareness about the importance of this critical issue, promoting parent-child communication, and investing in programs that have been proven to reduce teen pregnancy."
The Colorado Association for School-Based Health Care created promotional materials for the National Day to distribute at school-based health centers (SBHCs) throughout the state, as well as an additional survey about school-based health care. Twelve schools agreed to participate in the survey, and six of the schools returned over 350 surveys to be analyzed.
A major issue that emerged was the lack of marketing of the school-based health centers, as only 61.1% of the students who participated in the survey were aware that a clinic existed in their school. The National Day to Prevent Teen Pregnancy proved to be an effective marketing tool, informing the students of the SBHCs and encouraging them to visit and participate in the event. 23% reported having previously avoided seeking health care because of the cost, while 39% avoided it because of fear, nervousness, shyness, or embarrassment. An overwhelming 95.7% of the students believed that SBHCs within their schools would eliminate these barriers to care.
Not only was the National Day an effective way to promote awareness of school-based health centers, it also proved valuable in encouraging ongoing education within schools and clinics on the risks of unprotected sex. The survey provided short scenarios which challenged the students to consider what they would do in a number of sexual situations. 80% of the students said that the scenarios made them think about what they would do in the circumstances described, and 74.1% said they made the risks of sex and teen pregnancy more real to them.
Recommendations Based on Survey Results:
- Improve marketing for SBHCs to target fear and cost of care.
- Provide additional counseling in SBHCs to build students' skills in preparing for sexual situations so that they avoid having to make decisions "in the moment".
- Increase the availability of reproductive health services within SBHCs and emphasize trust and confidentiality in marketing campaigns to decrease fear and shyness around accessing these services. |
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The Nurse Practice Act and SBHCs
The Colorado Department of Regulatory Agencies (DORA) released its Sunset Review of the Board of Nursing on October 15, 2008. DORA recommended that the collaborative agreement requirement for Advanced Practice Nurses (APNs) with prescriptive authority be modified and that the limitations on the types of medication that APNs may prescribe within their scope of practice be removed.
Shortly after release of this report, some medical associations demanded input into the process. In response, DORA convened a workgroup comprised of five nurses representing Colorado Nurses Association and five physicians representing Colorado Medical Society.
After examining the issues, workgroup members made several recommendations to DORA. The recommendations are interrelated and not intended to be implemented separately. These recommendations were incorporated into a bill that reauthorized the Nurse Practice Act. There are several significant changes that will have a substantial effect on the APN's ability to obtain prescriptive authority in Colorado.
Under the old rules, a new APN graduate had to obtain a graduate degree in a nursing specialty; meet pharmacology course requirements; have national certification; and have professional liability insurance. The new rules require all of the above plus a 3600 hour post graduate mentorship with a practicing Colorado physician or a physician and an APN. The mentorship must be completed within five years.
An articulated plan must be developed which documents how the APN intends to maintain ongoing collaboration with physicians and other health care professionals regarding prescribing medications. The articulated plan must identify a mechanism for referral, quality assurance, decision support tools, and documentation of ongoing continuing education. The plan must be signed by a physician.
APNs who currently have prescriptive authority in Colorado must have an articulated plan signed by a physician, professional liability insurance, and national certification. Those APNS moving to Colorado who have prescriptive authority from other states must have 3600 hours of documented experience as a prescriber in addition to the articulated plan and other requirements.
Some fear the biggest impact of these new rules may be in areas with provider shortages, such as rural areas. "The new changes have increased physician oversight in the ability of APNs to prescribe in Colorado under the guise of "ensuring public safety," but unfortunately may well result in no care at all in many rural areas," says Sherrod Beall of Durango. Beall worries that obtaining 3600 hours of physician mentoring and an articulated plan with a physician signature is problematic in provider shortage areas.
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People, Resources and Events
The 2009 Colorado Health Symposium The Symposium, hosted by the Colorado Health Foundation, will be held on July 30 through August 1, 2009 at the Keystone Resort & Conference Center. The Symposium will offer a real-time look at the proposals to fix health care, providing a variety of perspectives on the major themes of these current efforts. For more information, go to www.coloradohealth.org/yellow.aspx?id=3604.
Fifth Annual Pediatric Sleep Medicine Conference: Next Steps in Research, Patient Care, Policy, and Education This conference will be held on October 2-4 at the Westin hotel in Westminster. The annual conference is designed to bring together a multi-disciplinary group of basic and clinical researchers, clinicians, educators, policy makers, and trainees involved in pediatric sleep medicine. For details, go to www.pedsleepmedconference.com/conference .
Making Proud Choices - Training of Educators Making Proud Choices is a science-based sexuality education curriculum for middle school youth. The training will be held on August 10th-12th (2.5 days). For more information, go to www.coappp.org.
The Bright Mountain Foundation holds two grant cycles per year. The grant cycle for organizations seeking funding for HIV/AIDS related programs begins in August. The grant cycle for organizations seeking funding for Children/Youth related programs begins in January. A letter of inquiry is required of all interested grant seekers. Please see Guidelines, Deadlines, Funding Focus, and Application for information on how to apply to the foundation. No unsolicited proposals are accepted. For more information, go to www.brightmtnfdtn.org.
The Colorado Health Foundation grant deadlines occur quarterly The next deadlines are July 15 and October 15. To speak with a TCHF program officer, please call the main number, (303) 953-3600, or toll-free at (877) 225-0839, and you will be directed to the most appropriate person. To see the guidelines and to apply for a grant online go to www.coloradohealth.org/apply.aspx.
Raising the Bar: Putting the Promise to Practice in Adolescent Reproductive Health and Support for Young Families The annual conference of the Colorado Organization on Adolescent Pregnancy, Parenting and Prevention will be held on October 8 and 9 (pre-conference on October 7). Scholarships are available to aid teen parent programs, teen/parent social workers, Title X clinics and school-based health centers from around the state in attending the event. To obtain the proper paperwork and instructions for your scholarship please contact Alexandra Eisler at aeisler@coappp.org or call 303-225-8870 ext 7. For information about the conference in general, go to www.raisethebarcolorado.org.
Grant Deadline for the Caring for Colorado The next deadline for grant applications to Caring for Colorado is October 2, 2009. To see grant guidelines or to obtain a grant application, go to the foundation's website at www.caringforcolorado.org.
Sign Up to be Notified of New Funding Opportunities by The Colorado Trust To be automatically notified of RFPs offered by The Colorado Trust, sign up online by going to www.coloradotrust.org/sign-up. You may also request to receive a variety of other updates from The Colorado Trust at the same time.
Free Tobacco Cessation for Students Available Colorado Clinical Guidelines Collaborative works with providers across the state to assist them in integrating tobacco cessation and alcohol and substance abuse screening, brief intervention and referral to treatment (SBIRT) into their clinical practices. For more information, contact Debbie Dion at 303-962-8993 or tobaccoinfo@coloradoguidelines.org. | |
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