Grantmakers In Health Webinar: School Health Center Sustainability Kimi Sakashita Alameda County, California O October 23, 2012 b 23 2012
Profile of Alameda County Alameda County California Population (2009) 1,556,657 38,292,687 Land Area (square miles in 2009) 738 155,959 Persons (per square mile in 2009) 2,110 246 College Graduates (persons 25 and over in 2007) 46.3% 36.7% Housing Units (2009) 573,111 13,530,719 Homeownership Rate (2007) 57.3% 58.4% Median Household Income (adjusted 2007 dollars) $66,430 $58,361
Alameda County Safety Net School Based Health Centers Day Labor Community Centers Colleges GACH EMS Health Care for Fire Stations URGENT CARE the Homeless and Trust Clinic PRIMARY CARE PORTALS PREVENTION
Health Portals A Health Portal is a new access point for primary and A Health Portal is a new access point for primary and preventative care, fully integrated in the existing health care system, but serves as an extension to the primary care home Portals are designed to the primary care home. Portals are designed to meet patients where they are at, at a time that is convenient to them. Portals also help residents understand and access health care coverage. g Portals provide the 3 P’s : • P oint of Entry • P lace for Health Services • P athway to Resources
School Health Centers Point Place & Pathway to achieve Point, Place & Pathway to achieve health and education equity q y
School Health Centers School-Based Behavioral Local Systems Building Health Initiative Health Initiative Service coordination Service coordination Align shared vision & framework Align shared vision & framework Medical services Promotion of positive social- Maximize & expand services emotional development Mental health services Leverage resources Behavioral health services Health education Integrate health and learning supports F Family supports il Youth development Develop tailored strategies Service coordination & capacity building Crisis Response 11 Initiatives 26 School Health Centers Berkeley 2020 Vision 150+ School-based behavioral Emeryville School Health Initiative health school sites 15 high schools Fremont School Health Initiative 7 iddl 7 middle school h l Hayward Full Service Community School 9 School district New Haven School Health Initiative 1 elementary school consultation and capacity Newark School Health Initiative building programs 1 community college Oakland Community Schools Initiative 1 Youth Center San Leandro School Health Services San Lorenzo School Health Initiative S L S h l H lth I iti ti 1 multi-school campus Tri-City FSCSN Initiative 9 school districts Tri-Valley School Health Initiative
SUSTAINABILITY: OVERVIEW Our initial SHC Sustainability work started with the UCSF evaluation team UCSF evaluation team Purpose was to collect and synthesize data to advance SHC sustainability in Alameda County SHC sustainability in Alameda County 1. 2011 Sustainability Assessment Tool Implemented an assessment tool to describe current sustainability Implemented an assessment tool to describe current sustainability – models and provide recommendations. 2. Discussions with SHC Directors Held follow-up discussions regarding qualities that lead to strong – and thriving SBHCs. Institute for Health Policy Studies School of Medicine
SUSTAINABILITY: FACTORS 2011 Assessment Tool: Staffing 2012 NASBHC Provision of Services Convening: Convening: Facilities Quality Marketing and Outreach Integration School Integration School Integration Financing/Operations Community Partnerships Funding Strategies Funding Strategies Institute for Health Policy Studies School of Medicine
INTEGRATION Schools and Districts Community-Based Community-Based Organizations Youth & Family Partnerships Health Care Increase Juvenile Justice Services Agencies Agencies Agency Sustainability Social Services Funders A Agency Cities
INTEGRATION • African American Male Oral History • Latino Men & Boys Project • Youth Organizing and Leadership Opportunities (YOLO) – It Stops with Me Campaign to end drugs, violence and dysfunctional families y • Oakland Based Urban Gardens (OBUGs)
QUALITY Quality: Service Delivery Q y y Current Strategies Draft Indicators 1. Equity i Monthly SHS contractor 2. Scope of Practice meetings meetings 3. Capacity Monthly data collection 4. Evaluation requirements in ETO q Quarterly narrative reports Safety Net Provider y Meetings Professional Development T Trainings and Conferences d C f Evaluation
School Health Centers Increase Health Access & Utilization I H l h A & U ili i 70,000 51,715 60,000 41,519 41,802 50,000 33,614 40,000 25,737 27,078 27,394 Visits s ts 18,818 20,186 20,975 Clients 30,000 12,581 20,000 11,399 9,515 8,968 7,276 6,624 6,642 10,000 6,170 5,577 5,748 5,010 4,047 0 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 (07) (08) (10) (10) (11) (11) (12) (12) (14) (18) (22)
School Health Centers I Increase Health Access & Utilization H l h A & U ili i Percentage of school population who were SHC Clients Percentage of school population who were SHC Clients 45% 44% 39% 35% 31% 30% 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 (11) (12) (12) (14) (18) (22)
Percentage of SHC Clients by Gender g y 35% 37% 37% 39% 39% 40% 65% 63% 63% 61% 61% 60% 06-07 06 07 07 08 07-08 08 09 08-09 09 10 09-10 10 11 10-11 11 12 11-12 Male Female
Percentage of SHC Clients by Race g y 4% 7% 4% 7% 11% 7% 6% 6% 5% 7% 9% 11% 11% 10% 10% 11% 11% Other Other 9% 14% 18% 16% 14% Bi-Racial/Multi-Racial 14% White/Caucasian 28% 27% 26% 28% 28% Asian/Pacific Islander Latino/a or Chicano/a African American 36% 36% 36% 34% 31% 06-07 07-08 08-09 09-10 10-11
Youth Participants Report Improved Academic & Personal Indicators Academic & Personal Indicators 78% 63% 62% 58% 52% 52% 46% Before program 36% After After 30% program 25% 20% Received Mostly A's Felt Very Satisfied Felt Very Connected Never/Rarely Missed Never/Rarely Felt or B's with School to People at School School Bored After School Experience Data Source: Youth Program Post Survey 2010-11 (n=179-204)
FINANCING STRATEGIES 1 Core Local Support 1. Core Local Support 2. Third-Party Billing Revenue/Health Coverage 3 Partnerships with Philanthropy 3. Partnerships with Philanthropy 4. In-Kind Partnerships and Support 4. In Kind Partnerships and Support
FINANCING STRATEGIES Core Local Support Core Local Support Al Alameda County provides a yearly $105,000 d C id l $105 000 base allocation of flexible funding Measure A—local bond for health services M A l l b d f h l h – Tobacco Master Settlement Funding (TMSF) – Require 1:1 match Require 1:1 match – Blended funding for behavioral health care (EPSDT, – MAA, Medi-Cal/Medicare) Medi-Cal (Medicare), EPSDT, MAA –
FINANCING STRATEGIES Health Coverage Billing & Leverage Health Coverage, Billing & Leverage Connecting Kids to Coverage Imitative Sebelius Challenge – Third Party Billing Revenue State specific (FPACT, Sensitive Services Medi-Cal) – Blended funding for behavioral health care (EPSDT, MAA, Medi-Cal/Medicare)
FINANCING STRATEGIES Partnerships with Philanthropy Partnerships with Philanthropy • Funder support includes both funding and fundraising strategies – Helps diversify the funding before the grant ends H l di if th f di b f th t d • Commitment and involvement of the funder – Convening similar grantees (Atlantic Elev8) Convening similar grantees (Atlantic Elev8) – Participation in local programs (Kaiser) • Length of funding 4 years or more allowing SHCs Length of funding 4 years or more allowing SHCs to establish and embed themselves
FINANCING STRATEGIES In Kind Partnerships and Support In-Kind Partnerships and Support • Schools & Districts – Facilities and related costs (phones, electricity, etc) – Custodial C t di l – School Nurses (non ‐ billable services) • Leverage Extended Day Programs • Leverage Extended Day Programs – Youth Development/Peer Health Educators • Local Public Health Departments • Local Public Health Departments – Nutrition and Dental Programs – Public Health Nursing Public Health Nursing – Take Back the Tap Initiative
FINANCING SHC Funding Sources FY 2010 2011 SHC Funding Sources FY 2010-2011 County County 17% Mental Health City State 33% 33% 6% 6% 4% Federal 1% S h School District l Di t i t 8% Medical Revenue Private 20% 20% 6% CBO (Inkind) 5%
FINANCING SHC Funding Sources FY 2010-2011 SHC Funding Sources FY 2010 2011 County $1 452 052 $1,452,052 17% Other Funding Sources $7 217 596 $7,217,596 83%
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