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

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School Based Health Center

Bainbridge Elementary School Port Deposit, Maryland

The Bainbridge Elementary School Based Health Center Program is a successful collaboration between:  Union Hospital of Cecil County  Cecil County Public Schools  MD State Department of Education  Cecil County Health Department  Cecil Partnerships for Children, Youth & Families

Meet the Staff

Jamshid S. Mian, MD, FAAFP Medical Director & Board-Certified Family Medicine Physician

Meet the Staff

John S. Braxton, PA-C Certified Physician’s Assistant

Meet the Staff

Jennifer Day, RN Registered School Nurse

Where is the Center located?

Children do not need to leave school grounds or even walk

• utside. The Health Center is

located on-site, inside the school, near the nurse’s office. It has been set up just like a 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.

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The School Based Health Center Program

• pened for the students of Bainbridge

Elementary School in January of 2009 and then began offering services to staff and teachers in May of 2009. The Physician and/or Physician’s Assistant are routinely on-site Tuesdays & Thursdays from 10:00 AM until 2:00 PM. During this time they treat students and their siblings from age 3-13, along with teachers and other staff.

This immediate access to health care assists in avoiding health related absences and provides more time for education and instruction.

Why Bring the Doctor's Office into the School?

Students perform better when they show up for class, healthy and ready to learn. School-Based Health Centers bring the doctor's office to the school so students avoid health-related absences and get the comprehensive health care they need to succeed.

Why Bring the Doctor's Office into the School?

Parents and guardians also find that School- Based Health Centers are accessible and reliable and ensure that their child’s health needs are being met while they are in school and learning.

How can children see the doctor at school?

It’s easy to enroll children in the Health Center. Parents/guardians must complete consent, registration and health history forms to get started. Students will not be able to see the doctor unless these signed forms are on file with the school.

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What type of care is provided?

The Health Center physician will see students referred from the school

• nurse. These students may complain of

aches, pains, fever, rashes, injury or

• ther symptoms.

What type of care is provided?

Just like a family physician, the Health Center physician performs an initial examination, makes a diagnosis and treats the child’s symptoms right on the spot.

What happens if a child needs a prescription?

The School Based Health Center physician is able to write prescriptions for medications that a child may need to clear up an infection or relieve other symptoms.

How are records managed?

All patient records are recorded and maintained through an Electronic Medical Record (EMR) system.

How is the billing handled?

The Health Center is a state funded program dedicated to enhancing existing school health programs. Services provided by the physician are billed to the student’s insurance company for reimbursement. Patient’s without health care coverage are never denied services.

School Based Health Center Visits 2008-2009 School Year

5 10 15 20 25 30 35 40 45 50 Students 13 17 39 22 30 8 Staff 8 1 Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug A total of 129 patients were seen (120 children and 9 adults)

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School Based Health Center Visits 2009-2010 School Year

5 10 15 20 25 30 35 40 45 50 Students 21 24 14 10 13 16 27 16 7 9 3 Staff 8 10 2 1 1 4 10 2 4 2 Sep Oct Nov Dec Jan 10 Feb Mar Apr May Jun Jul Aug A total of 204 patients were seen (160 children and 44 adults)

School Based Health Center Visits FY2011 School Year

5 10 15 20 25 30 35 40 45 50 Students 3 12 15 14 24 Staff 1 2 5 4 Jul Aug Sep Oct Nov Dec Jan 10 Feb Mar Apr May Jun A total of 80 patients seen year to date (68 children and 12 adults)

What are the Benefits

The success of the School Based Health Center is in the number of patients seen on site. The immediate access has potentially decreased school absences and increased days of learning. The parents of the students have expressed much satisfaction in having the School Based Health Center open and providing good medical care to their children.

Insuring a Successful Future

Current efforts include:

• Increasing student enrollment and parental

support of completed enrollment packages (207 enrolled in 2009-2010; 168 YTD in 2010-2011).

• Performance improvement initiatives such as the

identification of specific disease states and implementing preventative measures to address asthma in 2008-2009 and childhood obesity in 2009-2010 (with BMI measurements/data collection).

• Assessment of an available site and additional

funding for a second School Based Health Center site in Cecil County.

• Finding appropriate funding for future programs.

Continuous Quality Improvement (CQI) Program

2009–2010 School Year

Childhood Obesity

Sentinel Condition: Obesity

Goals:

• Collect and analyze student data
• Establish goal oriented task for CQI
• Implement task
• Recollect data after implementation
• Data presentation
• Inclusions: Students registered at School Based Health Center
• Exclusions: Students who relocate or are not available
• 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)

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Continuous Quality Improvement (CQI) Program 2009-2010 School Year: Childhood Obesity

• Sentinel Condition: Obesity
• Prevalence: Overall increased from 23% to 31% in the

past year (adults and children)

• NHANES (National Health and Nutrition Examination

Survey): 66% adults and 14% children overweight

• By 2015: 2 in every 5 adults and 1 in every 4 children

will be obese in the United States.

• SBHC data: 179 students initially registered / 167

currently registered.

• Screening: Begins at age 2 (American Academy of

Pediatrics, AAP and AMA guidelines)

Continuous Quality Improvement (CQI) Program 2009-2010 School Year: Childhood Obesity

• Long term consequences: Increased risk of morbidity and

death from diabetes, hypertension, coronary heart disease, cancer (especially colon, prostate and breast), sleep apnea, degenerative joint disease, thromboembolic disorders, gallstones and dermatological disorders.

• Prevention: Data suggests that weight loss can reverse the

effects of obesity. Public Health focus throughout the states to begin early in life.

• Measurement tool: (CDC) BMI (Body Mass Index, kg/m2) –

correlates to direct measurement of body fat and concurrent health risks/cardiovascular risk factors.

• Adults: 25-29.9 (overweight), >30 (obese)
• ‘BMI-for-age’ used for children since BMI is age and sex-

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 2009-2010 School Year: Childhood Obesity

Weight Category: Percentile Range: Underweight: Less than the 5th percentile Healthy weight: 5th percentile to less than 85th percentile Overweight: 85th to less than the 95th percentile Obese: Equal to or greater than the 95th percentile

Continuous Quality Improvement (CQI) Program 2009-2010 School Year: Childhood Obesity

Target Behaviors (evidence based via Pediatrics.org)

• Limiting consumption of sugar-sweetened beverages
• Increasing consumption of fruits and vegetables
• Limiting ‘screen’ time to less than 2hours per day
• Eating breakfast daily
• Limiting eating out at restaurants (especially fast food restaurants)
• Encouraging family meals where everyone eats together
• Limiting portion size
• Promoting physical activity for at least 60 minutes each day
• Monitoring: Routine Physicals by a primary care provider
• Conclusion: Life long behavior changes are urgently needed to

lower health risks associated with obesity

6 Limitations

• Discovered inconsistency in how data

was gathered.

• Number of students who did not

return for post-data collection for various reasons.

PRE-ASSESSMENT 2009-2010 Summary of Children's BMI-for-Age

Boys Girls Total Number of children assessed: 91 78 169 Underweight (< 5th %ile) 2% 5% 4% Normal BMI (5th - 85th %ile) 45% 50% 47% Overweight or obese (≥ 85th %ile)* 53% 45% 49% Obese (≥ 95th %ile) 36% 23% 30%

*Terminology based on: Barlow SE and the Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120 (suppl 4):s164-92.

Prevalence of Overweight and Obesity

49% 30%

0% 10% 20% 30% 40% 50% 60% Overw eight or obese (≥ 85th %ile) Obese (≥ 95th %ile)

Percent

Prevalence of Overweight and Obesity, by Sex 53% 36% 45% 23%

0% 10% 20% 30% 40% 50% 60% Overweight or obese (≥ 85th %ile) Obese (≥ 95th %ile)

Percent

Boys (solid) Girls (hashed)

POST-ASSESSMENT 2009-2010 Summary of Children's BMI-for-Age

Boys Girls Total Number of children assessed: 83 67 150 Underweight (< 5th %ile) 0% 1% 1% Normal BMI (5th - 85th %ile) 40% 42% 41% Overweight or obese (≥ 85th %ile)* 60% 57% 59% Obese (≥ 95th %ile) 35% 34% 35%

*Terminology based on: Barlow SE and the Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120 (suppl 4):s164-92.

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Prevalence of Overweight and Obesity

59% 35%

0% 10% 20% 30% 40% 50% 60% 70% Overw eight or obese (≥ 85th %ile) Obese (≥ 95th %ile)

Percent

Prevalence of Overweight and Obesity, by Sex 60% 35% 57% 34%

0% 10% 20% 30% 40% 50% 60% 70% Overweight or obese (≥ 85th %ile) Obese (≥ 95th %ile)

Percent

Boys (solid) Girls (hashed)

Conclusions

• Ability to accurately report BMI

data not possible.

• Prizes therefore awarded to

students with the greatest weight loss during CQI Program (boy and girl awarded).

Continuous Quality Improvement (CQI) Program 2009-2010 School Year: Childhood Obesity

• Overall Average: 7.8 lbs weight gained
• Greatest Weight Loss in Pounds:

– Female = 10.2 lbs – Male = 9.0 lbs Continuous Quality Improvement (CQI) Program 2009-2010 School Year: Childhood Obesity

Next Steps:  Develop and implement staff competencies to ensure that data collection and recording is accurate and standardized going forward.  Encourage increased enrollment in the School Based Health Center to effectively increase future participation.  Distribute and educate Bainbridge Elementary School students and their parents on healthy nutrition and exercise habits throughout the school year.  Re-Assess current School Based Health Center student height and weight data; duplicate Summer Activate Program at the close of this school year.

Insuring a Successful Future

The future of this program lies on the continued support of everyone involved and by strengthening the present infrastructure. The funding for the program is a must in order to continue to provide such a valuable service to the

• community. Each year budgets are submitted and

evaluated in hopes that the program receives the financial support it needs to continue.

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Questions?