4_30_14 Joint Council Meeting
Present – Marcy Bradley, Deanna Rigby, Su Chafin, Mary Stephens
1.
A future meeting schedule still needs to be determined. There were not enough members
present to do so today. Will ask Awe Maduka if her staff can work on this as she previously
stated.
2. “Elevator speech” – the group discussed that the previously prepared White Paper and remarks
for JFC were consistent. In terms of “taking the pulse” of the community about the role of
SBHCs, there have been some raised tensions in New Castle Co. after the opening of the new
SBHC at AI HS. No new concerns raised in Kent/Sussex.
3. Reflections on FY13 PQ data that was shared:
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Table 5 – Interface Results. The group was very concerned how the raw data might be
interpreted. Based on the definitions used to complete this part of the assessment, the referrals
only reflect referrals to outside providers. Although it looks at outside providers, it does not
capture referrals to PCPs, which is currently a concern in the community, especially New Castle
Co. More importantly, it doesn’t reflect upon on the care provided in the centers.
The group was not sure how the specific answers to questions/site profiles would really help
them guide their care in sites. A way to highlight risk factors for students (like the former risk
profile) could be helpful to them when inviting students to programming. Ex. Tobacco use,
anger management. Looking at statewide data obtained from the YRBS data or secondary
school survey would highlight the key issues in the state that do require focus from all the
centers.
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4. Thoughts on alternative tools for risk assessment and outcomes:
The biggest concerns expressed by the group centered on the theme that assessing risk is different from
measuring outcomes. As previously stated and documented, the difficulties in implementing the PQ and
the opportunity costs associated with it (patient time and satisfaction, staff time, lack of
reimbursement) are a major barrier to its continued use. In addition, we really don’t feel it is measuring
outcomes.
In terms of outcomes, suggestions were made to partner with DOE and insurers in discussions to see if
it’s possible to measure outcomes that parallel those in the national literature about the value of SBHCs
(attendance, school completion, ED utilization). Other possibilities include looking at HEDIS measures
(successful pilot in CCHS sites with DPCI last year). NASBHC could be queried about best practices for
outcome evaluation. An initiative by Nemours addressing asthma control was also brought up. Could
the SBHCs/DPH learn more about this and see if there is a role SBHCs could play? This could potentially
generate disease specific outcome measures and enhance the potential for SBHCs to be seen as partners
with community providers in improving the health of teens.
Other potential outcome measures include adherence to recommended screening measures for
adolescents (AAP/USPSTF). Potential areas of focus include STI screening, HIV screening, evaluation of
BMI, and immunization status.
The group is interested in learning more about the DPH strategic plan and what other
outcomes/problems in the state DPH as a whole feels are important in this age group.
In terms of risk assessment, no validated tools were immediately identified by the small group as an
alternative. We will be asking an academic librarian to complete a lit search to help answer this
question. Use of the HEEADSSS and CRAFFT interview was felt to be a workable solution in the interim
when coupled with the PHQ2. The CRAFFT tool and the PHQ2 are both specifically recommended in the
updated AAP guidelines for screening for ETOH/Drugs and depression. The HEEADSSS interview
approach meets the AAP guidelines for a psychosocial behavioral assessment. Clinicians feel
comfortable incorporating these questions into a clinical interview. This approach is patient-centered
and efficient and there is no monetary cost to implementing. While it does not allow for data capture of
specific elements, risk categories could be highlighted for individual students. Completion of a risk
assessment could be documented.
In terms of physical assessment, the group felt that rather than just reporting height and weight as is
currently required, BMI by percentile should be captured. The analysis of BMI along with a 3 body
system PE, coupled with HEEADSSS and CRAFFT and appropriate anticipatory guidance would meet all
the required elements of the HEDIS AWC measure.
After the meeting, a small group from CCHS did view a demo of the web based RAAPS tool. It is an
evidence-based validated tool for risk assessment and also gives tailored feedback to patients based on
their individual risk profiles. It takes about 5 – 7 minutes to complete. We are awaiting more
information about cost and technical requirements, but preliminary information suggests that the
annual cost for more than 10 sites would be $300 per site per year with a $500 one-time fee for data
base creation. An electronic device (tablet, laptop, kindle) is needed to administer the test.