Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-5538

Title:

AN ACT REQUIRING A REPORT CONCERNING A PILOT PROGRAM FOR SCHOOL-BASED HEALTH CARE CENTERS.

Vote Date:

4/1/2013

Vote Action:

Joint Favorable Substitute

PH Date:

2/27/2013

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

To Require the Commissioner of the Department of Public Health in consultation with the Commissioner of Education to establish a school-based health center pilot program in five school districts to address: extended operating hours; service provision to students outside the school district; provision of behavioral health and other health care services other than those typically provided by school-based health centers; community outreach related to services provision; and receiving private insurance reimbursements.

RESPONSE FROM ADMINISTRATION/AGENCY:

Representative Roland Lemar: The enactment of this bill would establish a pilot program designed to study the effectiveness of school-based health centers in New Haven. I am confident that if this project is funded it will develop into a successful initiative that would deliver the expansion of essential preventative and primary care services to the children in our school system. This program will increase early diagnosis of potential mental problems and provide essential services in a timely manner.

NATURE AND SOURCES OF SUPPORT:

Dr. Mario Garcia, Director of Public Health, City of New Haven: The implementation of the Affordable Care Act (ACA) has created a mechanism to expanding insurance availability as well as making the need of primary care services more apparent. A coordinated delivery of school-based health services represents the best practical option for expanding coverage of primary and preventive care to the children of New Haven as the Medicaid Program Expands and the individual mandate increases the demand for services.

Coverage for mental health services is now included under essential health benefit plans and as the implementation the ACA moves forward school-based health centers will become the natural venue of delivery. A comprehensive approach to delivery requires coherent management and coordination of operations and the governance design must ensure multi-agency participation. Successful management of services demands consistent budgeting and billing procedures which must take into account the ACA guidelines.

William Clark, Chief Operating Officer, New Haven Board of Education: The New Haven School Change initiative goes beyond classroom learning and work to ensure that every child comes to the classroom ready to learn. We have been emphasizing the importance of school health and how physical health and wellness links with mental and behavioral health and student achievement. The Board of Education and the Health Department have been working to improve school-based health services in New Haven.

This proposal will integrate school health into the primary health network to build a foundational infrastructure to improve student health and academic success. If designed correctly, it has the potential to create a system that leverage community resources and federal reimbursements that are available under the ACA.

Mary Anne O'Neill, Community Providers Association (CPA): CPA strongly supports expanding school-based health services and encouraging direct collaboration between the schools and community providers to improve identification of children and adolescents who have signs and symptoms of behavioral health issues. Once students with behavioral health issues are identified they will be linked to mental health services that are in partnership with community-based child guidance clinics. This will assure that these children and their families are linked to a community system of care, and would build upon the current system of enhanced care clinics, child guidance clinics, and behavioral health emergency response systems funded by the Department of Mental Health and Addictions Services and the Department of Children and Families.

Ray Rossomando, Connecticut Education Association (CEA): Children facing the greatest challenges in the classroom quite often experience poor access to nutrition and health care, as well as other challenges and needs associated with poverty. Public schooling must also be about the daily needs of students and their access to services, support, and resources that are enriching to the mind, body and readiness for learning.

We urge committee members to consider broadening the reach of this proposal to include integration with other after-school services currently available to students and their communities. Various cities across the country, such as Newark, New Jersey, are building community partnership around the commonsense notion that by combining school-based social services, after-school programs, and intervention that specifically address local challenges (health, nutrition, jobs, and safety) schools can better meet the need of students.

NATURE AND SOURCES OF OPPOSITION:

Jeanne Flynn, MSN, APRN, Hartford School Health Professionals, AFT Local 1018A/B: While I am not opposed to research into the area of integration of care, I am unable to fathom a system that would work equally well in all settings.

The concept of using “best practices” in a clinical setting refers to identifying the best diagnostic, treatment and preventative techniques to guide care for a give patient population and is typically based on research. Our clinical practice is guided by the American Academy of Pediatrics and meets national standards. School-based health clinics function similar to an urgent care setting given that we are not the child's primary care provider. In the Hartford school system we work closely with both private practices and community clinics to coordinate appropriate care for our children. The barriers to integration of care vary by setting depending on the accessibility of staff and the business of any given practice.

I cannot imagine any one system that would work equally well for urban, suburban, rural, private and community setting.

Reported by: Beverley Henry

Date: 04/01/13