Neighborcare Health Creates a Health Care Home in Public Schools
Thursday, July 18, 2013
Posted by: Joy Ingram
by Katie Bell, MBA, MHA, Chief Operating Officer and Mardie Rhodes, Communication Manager, Neighborcare Health
School is out for the year, but while the students are enjoying their summer vacation, Neighborcare Health staff members will be getting ready to add four new sites to a growing list of school-based health centers (SBHCs). When the school year starts in September 2013, Neighborcare Health will be operating in 14 different schools: six elementary schools, three middle schools and three high schools, with mental health only programs at twoadditional sites.
Under leadership from Mayor Norm Rice in 1989, voters passed the City of Seattle Families and Education Levy, which included support for school-based health centers. Seattle voters have supported the Levy in subsequent years through the most recent 2011-2012 Levy. "We knew that students needed health services in the schools. I am gratified by the success of this program and the number of students who are healthier because of it,” said former Mayor Rice, when celebrating the 20th anniversary of the Levy.
Neighborcare Health began operating school-based health centers in 1992. Recognizing that healthier youth are better able to succeed in school, Neighborcare is committed to the goal of ensuring that every student in Seattle schools has access to health care, including oral health. A deep partnership with schools has been a strategic goal, endorsed by Neighborcare’s leadership and board of directors. All of Neighborcare’s school-based health centers are located in Seattle Public Schools, usually in the most low-income, diverse neighborhoods.
“There’s an intrinsic tie between health care access, academic achievement and life success and the sooner we can reach these students, the better,” explains Colin Walker, school-based program manager. “The health centers provide an opportunity to deliver care to students where they spend their time, in school. The staff members are ingrained in the building and part of the school culture and environment. They have a more complete picture of what support services are available to meet student’s needs.”
Walker points out that many of the students in the Neighborcare school-based health centers are also being seen in Neighborcare Health’s medical and dental clinics. “It’s an opportunity to think about how we partner on care,” he says. “Knowing what schools the youth in our clinics attend can help us determine which schools most need support and service.”
An Integrated Model of Care
School-based health centers are staffed by nurse practitioners, mental health therapists and a clinic coordinator or health coordinator. School nurses on site are usually co-located with the health center, working closely with the health center team as an essential partner in school health services.
Services provided on-site include primary care, health education, sports physicals, individual and group therapy, immunizations and most recently, primary oral health services. Students can be treated for acute illnesses such as flu or chronic conditions like diabetes and asthma. They can also be screened for dental, vision and hearing problems.
Students must be registered with the school-based health center to receive care. A completed registration form with parent or guardian signature provides consent and access to all services. Under Washington State law, students under 18 can register themselves for confidential care, including reproductive health services at any age and mental health counseling and drug and alcohol services at age 13 and above.
Before- and after-school appointments are available and students with a pass can also visit the clinic during the school day as needed. School-based health centers are open whenever school is in session.
Adding Oral Health Services
During 2011–2012 school year, Neighborcare Health staff members conducted dental screenings at a number of Seattle elementary schools. The results were alarming. Nearly 19 percent of the children had visible oral health issues or decay. Oral health pain affects children’s overall health and their ability to succeed academically.
On June 4, 2013, Seattle Mayor Mike McGinn announced an additional award from Seattle’s Families & Education Levy for Neighborcare Health’s school-based oral health program to continue the work we started last year.
Neighborcare will work with students and families in need of additional oral health care to ensure they are accessing their dental home, if they have one, or to help them establish a regular source of care. For students with significant barriers to access outside of school, Neighborcare will also provide on-site primary oral health services at their SBHCs using portable dental equipment.
School and Community Collaboration
Neighborcare has been collaborating with schools to meet the Families and Education Levy’s (Levy) academic performance targets since 1992. The School-based Program leadership team, and on site teams meet with school administration and staff regularly to explore opportunities for improved care. Investment Plans describing service coordination, management, and referral processes are developed at each school site and reviewed annually.
In addition, Neighborcare collaborates with a number of community-based and school-based service providers to address student needs beyond the School-based Program’s scope of services (e.g. Neighborcare refers students to Seattle Children’s Hospital for specialty oral health services; consults with psychiatrists from Children’s and UW, and connects families to community mental health agencies for summer and some long-term services).
The Neighborcare Health school-based health centers are funded through government grants, reimbursement and contributions. The City of Seattle Families & Education Levy funds approximately 60 percent of operations each year.The remainder of the operational costs are covered by Neighborcare Health, and grants from the School-Based Health Alliance, Health Resources and Services Administration (HRSA), the City of Seattle and others as well as billing private medical insurance for some services, when students are insured.
School-based health centers make a difference in student’s lives. Recent studies cite that users of SBHCs experience greater satisfaction with their health, more physical activity and greater consumption of healthy food than non-users.In addition, users of school-based health centers show increases in attendance and grades. Students using mental health services also show grade point average increases over time.
Neighborcare’s school-based health centers served 2,453 students in 2012. Sixteen percent of the students were uninsured; 7 percent were homeless or recently homeless; and 54 percent of the students with known incomes were living in poverty. The students are diverse; 62 percent are students of color. Ten percent of the students were best served in languages other than English (24 languages). Table 1 presents the diverse student population at Neighborcare’s School-based Program sites in 2012. Many of these students have limited access to care outside of the school due to barriers and benefit greatly from school-based services.
Table 1: Neighborcare’s School-based Program Sites
2011-2012 School Year Data
Services & Programs
Students of color
Free & reduced lunch
Chief Sealth High
West Seattle High
Total / Average
Source: OSPI Data 2011-2012
While the outcomes measuring improved health behaviors and school attendance are significant, the students themselves provide an important measure of why we do this work.
“Not a lot of people ask what we want. In group, we talk about careers, becoming men, relationships, money and being stuck between cultures. We can’t really talk to our parents about that.”
Member of the Young African Men’s group at Roosevelt High School.
“My teeth were so bad, I used to bite my cheeks to keep from smiling. I was scared of going to the dentist, but [my provider] at the Center convinced me to get care. I finally did, and now people say I smile too much!”
Patient at Denny School-Based Health Center
“When we walk into the Health Center, everybody smiles at us. That doesn’t always happen in middle school.”
Patient at Denny School-Based Health Center
Additional information is available from the following sources:
The School-based Health Alliance (http://www.sbh4all.org)
WA Alliance for School Health Care (www.schoolhealthcare.org)
OR School Based Health Care Network (http://osbhcn.org/)
US Department of Health and Human Services (http://www.hrsa.gov/ourstories/schoolhealthcenters/)
 Am J Public Health. 2010 Sep;100(9):1604-10. doi: 10.2105/AJPH.2009.183590. Epub 2010 Jul 15.
 J Adolesc Health. 2010 Mar;46(3):251-7. doi: 10.1016/j.jadohealth.2009.07.002. Epub 2009 Aug 28.
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