Improving Adolescent Health
Outcomes
Hayley Lofink Love, PhD
Director, Research and Evaluation
School-Based Health Alliance
Agenda
1. Adolescent health challenges
2. Rethinking healthcare
3. School-based health centers as a
solution
Fragmented care Duplicated care
Emergency department use
Incomplete care
current health care system
is failing to meet the needs
of adolescents
Convenient
CONFIDENTIAL
AccessibleCulturally and
developmentally
appropriate
adolescent-centered care
Teen pregnancy
Substance use School
and addiction
failure
Violence/trauma
Inter-related
Costly
Preventable
Long-term threats to
health and wellbeing
risk for obesity,
alcoholism,
Level of
depression
school
Early
engagement
School performance
pregnancy
Adverse childhood
experiences
Involvement in
criminal
Lifetime
justice
earnings
Health
system
outcomes
Death rate
School failure
Product: broaden concept to ameliorate
effects of nonclinical determinants
(Inadequate food, housing, safety)
Place: beyond medical complex
in neighborhoods
Provider: nontraditional team members
(Community outreach workers, heath educators, coaches,
resource coordination)
Realigning health
with care
Rebecca Onie, Paul Farmer, & Heidi Behforouz. Realigning Health with Care. Stanford Social Innovation Review
The evolving
health care system
2.0
1.0
Acute/
infectious
disease
Reducing deaths
3.0
Wellness/
prevention
Chronic disease Achieving optimal
Prolonging
disability-free life
health for all
Halfon, Wise, Forrest. The Changing Nature Of Children's Health Development: New
Challenges Require Major Policy Solutions Health Aff December 2014 33:122116-2124
1. Point of entry to primary prevention, risk reduction
and care management system
2. Inter-disciplinary team: whole child approach that
unifies mind and body
3. Screen/address behavioral health needs often
undetected and unmet by mainstream PC system
4. Meets young people where they are (literally) in terms
of problems, pain, social and developmental challenges
5. Unprecedented opportunity for population health
Schools in the health
neighborhood
1. Provide quality, comprehensive health care services that
help students succeed in school and in life.
2. Located in or near a school facility and open during school
hours.
3. Organized through school, community, and health provider
relationships.
4. Staffed by qualified health care professionals.
5. Focused on the prevention, early identification, and
treatment of medical and behavioral concerns that can
interfere with a student’s learning.
School-based health center
characteristics
SBHCs: The Evidence Base
1. Increased use of primary care
2. Reduced inappropriate emergency room use
Greater than 50% reduction in asthma-related emergency room visits
for students enrolled in NYC SBHCs
3. Fewer hospitalizations
$3 million savings in asthma-related hospitalization costs for students
enrolled in NYC SBHCs
4. Access to harder-to-reach populations - esp
minorities and males
Adolescents were 10-21 times more likely to come to a SBHC for
mental health services than a CHC or HMO.
SBHCs: The Evidence Base
More than
2000 SBHCs
49 of 50 states
and in DC
Locations of SBHCs Nationwide (n=1930)
Alaska
Marshall Islands
Puerto Rico &
Virgin Islands
Hawaii
SBHC Sponsor Agency (n=1341)
33.4%
Community health center
26.4%
Hospital/medical center
13.3%
Local health department
11.3%
School system
6.3%
Private, non-profit
Other
4.2%
University
3.6%
1.3%
Mental health agency
Tribal government
0.3%
0%
5%
10%
15%
20%
25%
30%
35%
> 31 HOURS/WEEK
66.6
%
(n=1295)
AFTER SCHOOL
73.1
%
(n=1284)
BEFORE SCHOOL
60.8
%
(n=1285)
Provider
Types
in SBHCs
Primary
Care
100%
Mental
Health
70.8%
Oral
Health
15.9%
Nursing or
Clinical
Support
85.8%
Health
Educator
16.0%
Dietician
10.7%
(n=1381)
(n=978)
(n=219)
(n=1185)
(n=221)
(n=148)
SBHC Staffing Profiles
(n=1381)
%
29.2
Primary Care
%
33.4
Primary Care &
Mental Health
%
37.4
Primary Care &
Mental Health Plus
Mental
Health
Oral
Health
Reproductive
Vision
Health
Screening
Immunizations
Injury and
Violence
Prevention
Alcohol,
Tobacco, and Drug
Use Prevention
Healthy Eating,
Active Living, and
Weight Management
70.6%
have a pre-arranged
source of after-hours
care
52.7%
use electronic health
or medical records
(EHR/EMR)
Revenue Supporting SBHCs
(not including in-kind donations) (n=1286)
74.7%
State Government
53.4%
Federal Government
Private Foundations
40.4%
School/School District
33.1%
Hospital
32.6%
County/City Govt.
32.3%
27.4%
MCO/Private Insurer
Corps./Businesses
SBHA
18.4%
6.6%
State Network/Assoc.
5.1%
Tribal Government 1.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
%
87.9
report
billing at least one
insurance program
(n=1272)
Patient Revenue by Source
%
85.9
%
64.0
Public Sources
Private Sources
(n=1273)
(n=1300)
%
50.0
Self-pay (n=1309)
%
81.6
State Medicaid
Agency (n=1309)
%
71.4
Medicaid MCOs
%
63.0
CHIP (n=1307)
64.0%
(n=1311)
2500
2000
%
1500
1000
500
Grow the number of SBHCs by 2018
0
1987
1988
1993
1997
1999
2002
2005
2009
2011
2014
%
SBHCs to document performance standards
Questions?
Contact information:
Hayley Lofink Love
hlofink@sbh4all.org