School Based Health Center MD State Department of Education Cecil - PDF document

The Bainbridge Elementary School Based Health Center Program is a successful collaboration between:  Union Hospital of Cecil County  Cecil County Public Schools School Based Health Center  MD State Department of Education  Cecil County Health Department Bainbridge Elementary School  Cecil Partnerships for Children, Port Deposit, Maryland Youth & Families Meet the Staff Meet the Staff Jamshid S. Mian, MD, FAAFP John S. Braxton, PA-C Medical Director & Certified Board-Certified Physician’s Assistant Family Medicine Physician Where is the Center located? Meet the Staff Children do not need to leave school grounds or even walk outside. The Health Center is Jennifer Day, RN located on-site, inside the school, near the nurse’s office. Registered It has been set up just like a School Nurse physician’s office with two exam rooms, offices and a reception area. The office is stocked with all of the supplies the physician will need to evaluate, diagnose and treat a child. 1

The School Based Health Center Program The Physician and/or opened for the students of Bainbridge Physician’s Assistant are Elementary School in January of 2009 and then routinely on-site Tuesdays began offering services to staff and teachers in & Thursdays from 10:00 May of 2009. AM until 2:00 PM. During this time they treat students and their siblings from age 3-13, along with teachers and other staff. Why Bring the Doctor's Office into the School? This immediate access to health Students perform better care assists in when they show up for class, avoiding health healthy and ready to learn. related absences School-Based Health Centers and provides bring the doctor's office to more time for the school so students avoid education and health-related absences and get the comprehensive health instruction. care they need to succeed. How can children see the Why Bring the Doctor's Office doctor at school? into the School? Parents and guardians It’s easy to enroll children in the Health Center. also find that School- Parents/guardians must Based Health Centers complete consent, are accessible and registration and health reliable and ensure history forms to get that their child’s started. health needs are Students will not be able to being met while they see the doctor unless these are in school and signed forms are on file learning. with the school. 2

What type of care is provided? What type of care is provided? Just like a family physician, the Health The Health Center physician will see Center physician performs an initial students referred from the school examination, makes a diagnosis and nurse. These students may complain of treats the child’s symptoms right on aches, pains, fever, rashes, injury or the spot. other symptoms. What happens if a child How are records managed? needs a prescription? The School Based Health Center All patient records are physician is able to write prescriptions recorded and for medications that a child may need maintained through an to clear up an infection or relieve other Electronic Medical symptoms. Record (EMR) system. School Based Health Center Visits How is the billing handled? 2008-2009 School Year The Health Center is a 50 state funded program 45 dedicated to enhancing 40 existing school health 35 programs. 30 25 Services provided by the 20 physician are billed to the 15 student’s insurance company for 10 5 reimbursement. 0 Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Patient’s without health 13 17 39 22 30 8 0 0 Students care coverage are never 8 1 0 0 Staff denied services. A total of 129 patients were seen (120 children and 9 adults) 3

School Based Health Center Visits School Based Health Center Visits 2009-2010 School Year FY2011 School Year 50 50 45 45 40 40 35 35 30 30 25 25 20 20 15 15 10 10 5 5 0 0 Sep Oct Nov Dec Jan 10 Feb Mar Apr May Jun Jul Aug Jul Aug Sep Oct Nov Dec Jan 10 Feb Mar Apr May Jun Students 21 24 14 10 13 16 27 16 7 9 0 3 Students 0 3 12 15 14 24 Staff 8 10 2 1 1 4 10 2 4 2 0 0 Staff 0 0 1 2 5 4 A total of 204 patients were seen (160 children and 44 adults) A total of 80 patients seen year to date (68 children and 12 adults) Insuring a Successful Future What are the Benefits Current efforts include: The success of the School Based • Increasing student enrollment and parental Health Center is in the number of support of completed enrollment packages (207 enrolled in 2009-2010; 168 YTD in 2010-2011). patients seen on site. The immediate access has potentially • Performance improvement initiatives such as the identification of specific disease states and decreased school absences and implementing preventative measures to address increased days of learning. asthma in 2008-2009 and childhood obesity in 2009-2010 (with BMI measurements/data The parents of the students have collection). expressed much satisfaction in • Assessment of an available site and additional having the School Based Health funding for a second School Based Health Center site in Cecil County. Center open and providing good medical care to their children. • Finding appropriate funding for future programs. Sentinel Condition: Obesity Continuous Quality Improvement (CQI) Program Goals: • Collect and analyze student data • Establish goal oriented task for CQI • Implement task • Recollect data after implementation 2009 – 2010 School Year • Data presentation • Inclusions: Students registered at School Based Health Center • Exclusions: Students who relocate or are not available Childhood Obesity • Onset of data collection: Fall 2009 • Implementation: May 2010 for Summer months • Recollect data: November 2010 • Data Presentation: January 2011 • Incentives: Free jump rope and children stickers for all entries • Prizes: Scooter for largest weight loss (male and female prizes) 4

Continuous Quality Improvement (CQI) Program Continuous Quality Improvement (CQI) Program 2009-2010 School Year: Childhood Obesity 2009-2010 School Year: Childhood Obesity • Long term consequences: Increased risk of morbidity and • Sentinel Condition: Obesity death from diabetes, hypertension, coronary heart disease, • Prevalence: Overall increased from 23% to 31% in the cancer (especially colon, prostate and breast), sleep apnea, degenerative joint disease, thromboembolic disorders, past year (adults and children) gallstones and dermatological disorders. • NHANES (National Health and Nutrition Examination • Prevention: Data suggests that weight loss can reverse the Survey): 66% adults and 14% children overweight effects of obesity. Public Health focus throughout the states to begin early in life. • By 2015: 2 in every 5 adults and 1 in every 4 children will be obese in the United States. • Measurement tool: (CDC) BMI (Body Mass Index, kg/m2) – correlates to direct measurement of body fat and concurrent • SBHC data: 179 students initially registered / 167 health risks/cardiovascular risk factors. currently registered. - Adults: 25-29.9 (overweight), >30 (obese) • Screening: Begins at age 2 (American Academy of - ‘BMI -for- age’ used for children since BMI is age and sex- Pediatrics, AAP and AMA guidelines) specific for children (amount of body fat changes with age and amount of body fat differs between girls and boys). Continuous Quality Improvement (CQI) Program Continuous Quality Improvement (CQI) Program 2009-2010 School Year: Childhood Obesity 2009-2010 School Year: Childhood Obesity Weight Category: Percentile Range: Target Behaviors (evidence based via Pediatrics.org) • Limiting consumption of sugar-sweetened beverages Underweight: Less than the 5th percentile • Increasing consumption of fruits and vegetables • Limiting ‘screen’ time to less than 2hours per day Healthy weight: 5th percentile to less than • Eating breakfast daily 85th percentile • Limiting eating out at restaurants (especially fast food restaurants) • Encouraging family meals where everyone eats together Overweight: 85th to less than the 95th • Limiting portion size percentile • Promoting physical activity for at least 60 minutes each day • Monitoring: Routine Physicals by a primary care provider Obese: Equal to or greater than the • Conclusion: Life long behavior changes are urgently needed to 95th percentile lower health risks associated with obesity 5