Q&A with the Oregon Health Authority: School-based health centers and health reform

Public Health Newswire spoke with the Oregon Health Authority about the role of school-based health centers in health reform. APHA’s Center for School Health and Education recently published a series of case studies, “Case Studies and Recommendations for School-Based Health Centers on Taking Part in Health Reform.” One case study charts OHA’s success in fostering new methods and ideas in the state’s school-based health centers. Read Public Health Newswire’s in-depth conversation about reform and innovation with OHA below.

1. What are school-based health centers and how are they helping improve health for students in Oregon?

School-based health centers support students’ physical and emotional health. Oregon’s 78 state-certified SBHCs are medical clinics that offer a full range of physical, mental and preventive health services to students, regardless of their ability to pay. All Oregon SBHCs are staffed with primary care and mental health providers, and some with on-site dental providers. SBHCs work closely with schools and school nurses to help youth stay healthy, in school and ready to learn.

SBHCs are located either within schools or on school grounds. By providing easy access to health care, SBHCs reduce barriers like cost, transportation and concerns about confidentiality that keep children and youth from seeking the health care services they need. SBHCs are open and operate when kids are in school. As a result, students are back in class faster than if they had sought health care in a non-SBHC setting. Parents do not need to take time off work in order to transport a sick student to the doctor.

2. What role does the Oregon Health Authority’s Public Health Division have in helping school-based health centers take part in health reform?

As part of the Oregon Public Health Division, the SBHC State Program Office works to ensure SBHCs are relevant during this time of change and innovation. Health reform in Oregon depends on cross-sector collaboration between public health, health care, early learning, education, and community-based groups, parents and students and the success of Oregon’s SBHC model comes from private-public partnerships.

The SPO not only ensures SBHCs are in compliance with state certification standards, which promote high-quality, youth-friendly care in alignment with current AAP Bright Future recommendations, but also provides leadership and ongoing technical assistance to SBHCs and partners to ensure sustainability. The SPO supports SBHCs and partners to develop strategies and policies to improve health of the population. Together, they also analyze, collect and report SBHC-specific data; convene and engagement diverse stakeholder groups and engage in cross sector partnerships and collaboration.

“As state and local policies continue to try to move the needle…SBHCs must be a part of these policy conversations.”

3. Why is it important for SBHCs to take part in health reform?

SBHCs play a very important role in providing primary care, preventive services, acute care and behavioral health services to Oregon’s school-aged population in a youth-friendly and supportive environment.

It is important that the role of SBHCs is understood and taken into account when health reform decisions are made. It’s also important that reform conversations occur at the community level. As state and local policies continue to try to move the needle on increasing comprehensive well visits, depression screenings, STI and pregnancy prevention, immunizations and behavioral health services, SBHCs must be a part of these policy conversations. SBHCs provide many of these services and have relationships with other youth-friendly providers in their communities.

4. What are some lessons that SBHCs have for other health care providers on meeting the health needs of children and adolescents?

The lessons that SBHCs could offer other providers are grounded in their mission to deliver youth-friendly, collaborative high quality care in an environment that minimizes academic disruption and puts youth and parents at the center of their care. SBHC providers are particularly attuned to issues that impact youth care such as confidentiality, consent, financial burden and the importance of warm hand-offs.

In order to truly deliver youth-centered care, providers need to develop trust and take the time to understand exactly what youth needs are. For example, SBHCs post their billing policies clearly and prominently in the clinic, and most try to review them verbally, so youth understand what happens if they use their insurance and what their financial responsibilities are.

Providers also spend time talking with youth about the importance of involving parents in their care, and presenting options for confidential care if parent involvement would be too risky for youth. If a youth needs services beyond what is available in the SBHC, the provider works hard to do a warm hand-off to a specialist so that youth feel supported in transitioning their care.

Lastly, SBHC providers strive to empower youth in developmentally appropriate ways to support them in directing their own care. While this may be a more time-intensive approach to primary care, it is consistent with the youth-centered philosophy of SBHCs.

“SBHCs give all students at the school the opportunity to be healthy and ready to learn regardless of insurance status, race, sex, gender identity, sexual orientation, religion, immigration status or disability.”

5. The theme of the 2018 APHA Annual Meeting and Expo is “Creating the Healthiest Nation: Health Equity Now.” How do school-based health centers support health equity?

Supporting health equity is part of the SBHC model’s foundation. SBHCs were created in response to health disparities among underserved adolescent populations. SBHCs give all students at the school the opportunity to be healthy and ready to learn regardless of insurance status, race, sex, gender identity, sexual orientation, religion, immigration status or disability.

SBHCs advance health equity by reducing barriers that young people and their families may face. SBHCs are often located in schools with a higher-than-average proportion of students in poverty, enrolled in Medicaid, uninsured, or with limited access to transportation. SBHCs are designed to be youth-friendly, responsive and youth-empowering. Many SBHCs have Youth Advisory Committees that empower youth to have input in their SBHCs and advocate for their health needs.

SBHCs strive to support the whole child by addressing social determinants of health. SBHC providers not only talk with students and parents about physical and mental health, but also assess for safety, resources and supports they may need. The cross collaboration between the various SBHC partners allows for SBHCs to impact students beyond the clinic walls.