Adolescents Use and Trust Their School-Based Health Centers
Adolescents often don't get the health care services they need because they don't believe that their visits will be confidential and they have limited access to transportation.* These and other non-financial" barriers to care can interfere with a child's ability to get health care even when that child is insured.** SBHCs bridge these gaps by providing child-centered care on-site in schools.
A recent study in the Journal of Adolescent Health found that SBHCs provide a point of access for teens who do not feel comfortable going to any other source of care. The study, conducted in Rochester, New York, evaluated the services provided to adolescents enrolled in commercial insurance, Medicaid, and those that used one of two SBHCs who were also enrolled in a public or commercial plan. The SBHC users were more likely than those enrolled in Medicaid or commercial insurance plans to receive critical screening and counseling and said that they trusted their centers as a confidential place to go for care. Key findings of this study are:
- SBHC users were more likely to report that their provider told them their discussions were confidential;
- SBHC users were more likely than Medicaid or commercially insured adolescents to receive screening/counseling on sexually transmitted diseases, HIV/AIDS, condom use, and birth control;
- Commercially insured adolescents were least likely to report discussion of sexual issues;
- SBHCs had the highest mean Young Adult Health Care Survey (YAHCS) quality measure scores for screening/counseling on pregnancy, STDs, diet and exercise, and helpfulness of counseling provided; and
- Medicaid-insured teens had the lowest scores on four of seven measures including preventive screening/counseling on risk behaviors, diet and exercise, depression, mental health and relationship issues, and communication and experience of care.
*Adolescents are among the least likely to have access to health care and have one of the lowest rates of primary care use of any age group in the United States. (US Office of Technology Assessment. Adolescent Health: I: Summary and policy options, 1991)
* Most teenagers don't believe that confidential care is available from their health care provider. (Klein JD, McNulty M. Flatau C. Adolescents' access to care: Teens' self-reported service use and perceived access to confidential care. Arch Pediatr Adolesc Med 1998; 152:676-82)
** 1 in 5 children miss routine doctors' appointments because their parents can't get them there. (Children's Health Fund Survey, 2001)
School-based Health Centers: A Model for Children's Mental Health
School-based Health Centers provide health and mental health services to over 200,000 students in underserved communities across the State. A core mission of SBHCs is to provide early detection and treatment of mental health conditions. To support this mission, the Coalition's number one priority in 2008 is securing Medicaid reimbursement for psychotherapy services provided by social workers to students in School-Based Health Centers. Current state rules prohibit Article 28 clinics from billing for these services unless the clinic is a Federally Qualified Health Center (FQHC).
State guidelines require "All SBHCs to address the mental health needs of enrolled students." The guidelines strongly recommend that every center serving adolescents "provide some level of on-site services," Principles and Guidelines for SBHCs, NYS DOH. Currently, the majority of SBHCs do offer mental health services on-site.
In addition, State DOH minimum staffing ratios require the same provider to enrollee ratio for mental health providers as for medical providers. This requirement reflects the high need for basic mental health services in the populations served by SBHCs.
The SBHC model was designed to reach students who would otherwise fall through the cracks in the mental health system. Numerous peer-reviewed studies provide solid evidence that this model works not only to increase access, but also to improve the overall mental health status of students, and save money by reducing complications and more costly treatments later on. Here is the evidence:
[1] Klein JD, Handwerker L, Sesselberg TS, Sutter E, Flanagan E, Gawronski B. Measuring quality of adolescent preventive services of health plan enrollees and school-based health center users. J Adolesc Health 2007:41 153-160.
[2] Juszczak, Linda, Paul Melinkovich, and David Kaplan, “Use of Health and Mental Health Services by Adolescents Across Multiple Delivery Sites,” Journal of Adolescent Health, Volume 32, Number 6, Supplement to June 2003, pp. 108-118.
[3] Santelli, J., A. Koukis and S. Newcomer, “ School-based Health Centers and Adolescent Use of Primary Care and Hospital Care,” J Adolesc Health 1996: 19 267-275.
[4] Kisker, E.E. and R.S. Brown., “Do School-based Health Centers Improve Adolescents” Access to Health Care, Health status, and Risk-taking Behavior?” J Adolesc Health 199618, pp. 335-343.
[5] Weist, Paskewitz, Warner, et al., “Treatment Outcomes of School-based Mental Health Services for Urban Teenagers,” Journal of Community Health, 1996, 32, pp. 149-157.
[6] Adams EK, Johnson V. An Elementary School-Based Health Clinic: Can it Reduce Medicaid Costs? Pediatrics 200: 105, pp. 780-788.