School-Based Health Care for Adults, Too

By Andy Snyder

September 2013
It’s the start of the school year, and some school-based health centers (SBHCs) are busy providing health services not just to students, but to adults as well. The School-Based Health Alliance reports that the number of school-based health centers that provide care to students’ families, school faculty, and the wider community is increasing.  As states look for ways to increase their capacity for primary care and ensure access to those who will be newly insured, innovative efforts in Oregon and Los Angeles show how states and communities can leverage SBHCs to expand access to care for adults.
 

Supporting Sustainability in Oregon
In July, the Oregon Public Employees’ Benefit Board (PEBB), which oversees the state employees’ health plan, made a $300,000 grant from its health improvement fund to help five SBHCs improve their financial sustainability and offer services to broader groups. This builds on an earlier grant from the Oregon Educators Benefit Board (OEBB).  Through these grants, the Oregon Community Health Information Network will assist SBHCs to adopt electronic medical records and to improve their ability to bill public and private insurance programs.
 
Joan Kapowich, PEBB/OEBB administrator, says that the initiative has several goals.  The first is to make sure that the SBHCs have a sustainable infrastructure so that they can take on more patients, including the teachers and state employees that PEBB/OEBB covers. The second is to help SBHCs qualify as Patient-Centered Primary Care Homes; PEBB/OEBB is working to encourage its members to use primary care homes, and an SBHC could be a very convenient way for state employees to access primary care home services.  In particular, it may reduce the need for teachers to take time off for routine care, and for schools to find substitute teachers.  The third is to shore up the availability of services in rural areas of the state, where other providers may be in short supply.  “In some cases, this is all folks have, and we want to make it as good as possible,” said Kapowich.
 
Los Angeles’ Wellness Centers
The Los Angeles Unified School District (LAUSD)—the nation’s second-largest school district—provides health services through SBHCs at 34 sites across the county.  But now, the District is launching an innovative expansion of its school-based health services.  Through a partnership with the Los Angeles Trust for Children’s Health (LA Trust), a non-profit organization founded by the district’s Board of Education, LAUSD is building thirteen full-service clinics called Wellness Centers on the campuses of schools in “health hotspots” across the city.  One of the goals of these centers is to provide care to students’ family members and the wider community.
 
The Wellness Centers are operated by Federally Qualified Health Centers—chosen because of their administrative capacity to bill Medicaid and other insurance, and their requirement to serve the uninsured—and provide a full range of primary care treatment and preventive services.  There is a strong emphasis on providing reproductive, mental and behavioral health services, and a desire to develop the capacity to provide oral health services.
 
The Wellness Centers’ primary mission is to serve the students in each Center’s “complex” – the high school where the Center is located, along with the primary and middle schools that feed into the high school.  From the outset, however, there was a strong secondary mission to reach outside the school and provide access to health services to students’ families and to the schools’ entire community.
 
Maryjane Puffer, executive director of the LA Trust, says that one of the strategic goals of the Wellness Centers is to change the health of their communities.  Particularly, the Wellness Centers are well-positioned to leverage the linguistic and cultural capabilities of school-based providers to influence community members and engage them in learning about behavior and nutrition changes.
 
As the centers ramp up to full implementation over the next several years, their goal is to eventually be able to provide after-hours and Saturday care, and build capacity at each Wellness Center to provide a minimum of 100 patient visits per week.   The Centers are also engaging with students and community members, to educate their potential clients about these new resources and to improve access to high-quality prevention, education, and health services.
 
If you would like to learn more about these topics, NASHP has many resources available on access and the safety net.  A factsheet and webinar detail state efforts to help safety net providers improve their billing capacity, and you can listen to a presentation by Maryjane Puffer describing the Wellness Center initiative.  As ACA implementation unfolds, school-based health centers may become one of many tools states will need in their kits to ensure access for the millions of adults gaining coverage in the coming years.