Essay Questions – Kristin Harsch
1. Describe your history and/or current role in school health.
I began my public health career with a position at a county health department developing
and implementing a reproductive health education program. In that role I worked closely with
school nurses, and quickly realized how big of an asset they are not only within their schools,
but to the surrounding community. Working with school nurses exposed me to the challenges
faced daily by schools to ensure the health and safety of their students, but also the
opportunities that lie within school settings to influence health behaviors, increase health status,
reduce barriers to care, and improve educational outcomes of adolescents. After 18 months in
that role, I decided to return home to Michigan.
My relocation allowed me to become part of one of the largest state-funded schoolbased health center (SBHC) programs in the country. I currently serve as a consultant for the
Child and Adolescent Health Center (CAHC) Program for the State of Michigan. My role is
primarily administrative, reviewing work plans, reports, and budgets, as well as providing
technical assistance to 14 of the 100 state-funded centers. Overseeing health center grants
requires knowledge of individual communities, health needs of students, understanding the
relationships each center has with the school(s) they work with, and working collaboratively with
coordinators, clinicians, and mental health providers. I conduct site visits to assure proper use of
state funds and that program requirements are being met.
As a site consultant, I am involved in the various state-funded initiatives and pilot
projects that my assigned health centers participate in. The CAHC program has recently begun
an impact evaluation of four of our 17 newly-funded SBHCs. This evaluation is a prospective
cohort design that is investigating the impact of CAHCs from 2015-2017. It utilizes multiple data
sets to evaluate the SBHCs impact on students’ health, access to care, health literacy, broader
impacts on school engagement and climate, as well as selected measures of academic
success. We are also pilot testing the use of telehealth units within select centers. School
nurses will be using a telehealth unit linked with a nurse practitioner at a CAHC or local
pediatrics office. This project aims to increase access to healthcare for students, increase
reimbursement for health services, as well as evaluate the acceptability and satisfaction of
youth who participate in telehealth visits.
I also established a networking group for the health educators working within the CAHC
program. Although only a dozen or so are employed within the program, I saw a need for
networking and collaboration, and also hope to bring attention to the assets trained health
educators bring to SBHCs. There has been an increasing interest in the networking meetings,
not only from health educators, but others in health centers that provide health education
services to their schools and communities.
I plan to continue to involve myself in new initiatives on the state level, but also continue
to build relationships with my health center providers to assure needs of their communities are
being met and resources provided.
2. What are your long-term goals working in the field of school-based health care?
How do you hope to use the skills and lessons learned in this program to further
those goals?
As a young professional, it is difficult to pinpoint specific long-term goals due to the rapid
growth of school-based health centers nationwide, as well as evolution within the Michigan
SBHC program. As I continue to learn about SBHCs and grow into my role as a consultant, I
believe it is beneficial to identify short-term goals and to revisit them regularly.
With the expansion of the Michigan Child & Adolescent Health Center Program, our team of
consultants has grown and roles and areas of focus among members have evolved. Those that
have been with the program for many years have broadened their work throughout the Child,
Adolescent & School Health Division at MDHHS. This growth has opened opportunities within
our state program for newer team members. One of my goals within the coming years is to
become the CAHC Program Coordinator.
The role of Program Coordinator would allow me to be involved in many program-wide
decisions and determine priority areas. Developing skills in strategic planning, causal decisionmaking, and systems alignment would no doubt be beneficial to me professionally, to our health
centers, and state program. The role would also allow me to set specific goals for our program
in areas such as: developing advocacy training for community partners, strengthen health
education within SBHCs, evaluating the impact of SBHCs, increasing revenue from billed
services (including mental health services), and continued focus on certifying SBHCs as patientcentered medical homes (PCMH). As state employees, as are prohibited from advocating for
funds. We rely on advocacy groups and SBHC partners to contact legislators, although limited
resources exist for training and encouraging them to do so. I hope to provide trainings to
increase grassroots advocacy within our health centers. We have a PCMH-focused workgroup
currently walking through the certification process with one fiduciary, and have discussed
developing a SBHC-specific certification on a state-level. Expanded knowledge on how other
health centers nationwide are working through certification would be incredibly helpful in the
process. I also aim to increase awareness of the assets and resources trained health educators
(HEs) bring to a school-based program. HEs are trained to not only provide education to
adolescents, parents, and school staff, but have specific skills in areas that compliment and
strengthen SBHCs, such as building youth advisory committees, engaging community partners,
strategic planning, and communicating the benefits of SBHCs with broader audiences, which
allows clinical and mental health providers the time to focus on serving patients.
Skills and lessons learned in the SBHA Leadership Fellows Program would be incredibly
beneficial. I have no prior experience working directly in a school-based health center, so
throughout the past 14 months I have been busy learning about all aspects of building and
sustaining them. The valuable knowledge and skills learned during the fellowship would not only
aid in my growth as a consultant to my assigned centers and the state-wide program, but would
also offer me a thorough understanding of the climate of school-based health nationwide.
3. What do you see as the greatest challenge facing school-based health care and
the school-based health center model? As a leader in the field, how would you
propose to address this challenge?
The future of school-based health hinges on the ability of centers to establish relevancy and
integration within the broader healthcare infrastructure. There are many complex components of
integration; certification as patient-centered medical homes, increased billing revenue for
services provided, advocating for and sustaining funding, as well as increasing awareness of
the benefits of school-based health centers to legislators, administrators in schools and health
systems, as well as the general public. These are just a few of the ways SBHCs can make
themselves more sustainable and relevant within an evolving healthcare system.
Generally, SBHC models are seen as satellite offices within their sponsoring agencies that
do not fit into traditional models of care, reimbursement for services, and financial efficiency. In
school-based and school-linked settings, priority is put upon spending ample time with
adolescents during healthcare visits, conducting risk assessments, and linking to healthcare and
community resources while the student is in the clinic. Services are also focused on the needs
of the specific community the health center serves, and services are provided in ways to meet
those needs. Staff in SBHCs wear many hats, and not only focus on the health of their students,
but aim to teach youth to be their own healthcare advocates, as well. This model does fit most
healthcare processes of seeing multiple patients within an hour with streamlined services.
Financial sustainability is the greatest challenge facing school-based integration. It is not
difficult to win the hearts of legislators and healthcare system administrators when discussing
the importance of healthy children and adolescents. It is more difficult, however, to justify the
costs associated with caring for the health and well-being of young people in school settings, to
from government and healthcare institutions. School-based health clinics have not traditionally
been seen as money makers; many sponsoring institutions struggle to fill funding gaps with
short-term grants and in-kind contributions from community partners. Resources are often taken
from other programs to support the gaps.
Addressing this issue involves thorough, reliable program evaluations in order to have data
to support funding efforts, working with high-level administrators in state agencies, managed
care organizations, and health plans on policy change to ensure services offered are being
reimbursed, streamlining billing for nurses and specific services (such as telehealth), PCMH
certification (particularly in areas with provider shortages), and integrating health centers within
not only their sponsoring healthcare institution, but throughout the community so as to utilize all
available resources.
I hope to have a long career ahead of me, and plan to address these challenges head-on by
continuing to build my professional network and identifying supporters and allies in local
communities, at the state level, and nationally. I also plan to continue strengthening evaluations
of our programs to sustain and increase financial support of SBHCs, and work closely with
partners in health plans to advocate for policy changes. With many small steps, I hope to be a
part of the efforts to sustain and increase growth of school-based health centers nationwide.