Public Health Committee
JOINT FAVORABLE REPORT
AN ACT CONCERNING SCHOOL-BASED HEALTH CENTERS.
Joint Favorable Substitute
SPONSORS OF BILL:
The Public Health Committee
REASONS FOR BILL:
The bill would establish a statutory definition of “school-based health centers” (SBHC) and allow the commissioner of public health to adopt regulations concerning minimum quality standards.
Defines an SBHC to be; 1) located in or near a school facility of a school district, school board, Indian tribe, or tribal organization; 2) organized through school, community, and health provider relationships; 3) administered by a sponsoring facility (hospital, health department, community health center, among others); and 4) provide comprehensive medical and behavioral health services to children and adolescents to state local law.
RESPONSE FROM ADMINISTRATION/AGENCY:
Commissioner Jewel Mullen, Department of Public Health (DPH): The bill establishes a definition for School-Based Health Centers (SBHC) and gives DPH the authority to adopt regulations to establish minimum quality standards. The language was recommended as a result of the work done by SBHC Advisory Committee.
NATURE AND SOURCES OF SUPPORT:
Robert Dudley: School-Based Health Centers (SBHC) are a vital point of entry and access for Connecticut's children to medical, behavioral and dental health services that they often cannot get elsewhere. Students are able to meet entry requirements and/or receive acute care and get back to learning, often with significant reductions in lost education time.
SBHC exist in many forms and are funded in a variety of ways. SB 917 would set minimum standards for School-Based Health Centers, and would assure that this safety net maintains and advances the health of students and communities.
Nancy Brescia, APRN: Our clinic provides a comprehensive array of direct service provision such as dental services, medical services, and behavioral health services. By establishing a School-Based Health Center (SBHC) definition and solid standards, consistency in the comprehensive model of high quality throughout our state would be ensured.
Statistical data suggests that SBHCs are well positioned to address our student's variety of mental health, dental, and medical needs in order to remain in school, stay attentive to learning, and to prepare for life after high school. We ensure our graduating students have all the necessary vaccinations and physical exams necessary for college entrance.
Dr. Hede, Dentist assigned to Hartford Public High School: Tooth decay is the single most common chronic childhood disease, 5 times more common than asthma and 7 times more common than hay fever. Nearly twice as many children with low socio-economic status ages 2-9 years of age have at least three decayed or filled primary teeth as compared to children from families with higher income levels. This is the case at our health care clinic.
Barriers to dental health services include, lack of awareness of seriousness of oral health, lack of or insufficient dental insurance, lack of transportation, parents/guardians cannot get time off from work to take student, limited income, and lost school time.
Deborah Poerio, President, Integrated Health Services, Inc.: To support our efforts to assure high quality services to address the needs of our children, a School-Based Health Center (SBHC) Advisory Board was created. The mission was to develop standards and a definition for SBHC's so parents who move to a community can be assured that the same quality and services exist in any other program referring to themselves as a SBHC.
I believe the definition is far too broad and allows programs that do not offer medical and behavioral services on site for 40 hours per week, to be considered a SBHC. Consideration must be given for another category for those programs that only offer one service or offer on-site medical and behavioral health services less than 40 hours per week. Programs offering only one service should not be responsible for coordinating care for the other disciplines if they are not providing them and would not be collecting comprehensive outcome data.
The suggestion to have separate categories would not have impact on currently funded programs, and could consider a “grandfathering in” of those programs that currently do not comply that are funded by the Department of Public Health.
Jane Hylan, Director, Community Health Center, Inc: Establishing a definition of School-Based Health Centers (SBHC) is an important goal, however, we must be careful to make sure the definition is accurate. SB 917 focuses only on a comprehensive model where medical and behavioral health services are both provided. Ideally, both services should be available at all schools but in some cases, a school can only support one service or another. The bill should include a definition for the inclusion of a SBHC to support behavioral health service as a stand-alone service. As the Sandy Hook Commission points out, the development and funding of behavioral health services is an important need in our state.
Susan Kelley, Keep the Promise (KTP): Section 1 of the bill is new and defines a School-Based Health Center (SBHC); lists eligible sponsoring facilities; and states that the Department of Public Health (DPH) may adopt regulations to establish minimum quality standards. Establishing a SBHC definition and creating standards will ensure that SBHCs throughout the state provide high quality health services and continue the use of Connecticut's current integrated service delivery model that blends medical care with preventive and behavioral health services. As a result of this integral model, SBHCs provide truly comprehensive health care services to our children and youth. Expanding the role of schools in addressing the behavioral health needs of children is central to the statewide Children's Behavioral Health Plan released in October of last year. The plan recognizes schools as ideal settings for carrying out intervention/prevention strategies and providing linkages to mental health services.
Stephen Karp, Executive Director, National Association of Social Workers (NASW): Section 1 of the bill calls for uniform standards of operation for school-based clinics, including behavioral health services. The National Mental Health Association reports less than 1 in 5 of the 12.5 million children in need of mental health services actually receive them. Many of these children would not achieve academic success due to social, emotional and behavioral problems affecting school performance.
Children who utilize school based health centers can access needed mental health care without embarrassment or stigma. Because the centers offer a range of health care services the purpose of a visit is not readily identifiable. The fact that children are already in school addresses the issues of accessibility, and care can be made affordable to all of the school's children.
We recognize that there are school based programs that offer just mental health services and that not all schools have the space necessary for a full school based health center. These limited in scope services are of value and while not being a full school based health center should continue to be supported.
We strongly recommend that being 2c in Section 1 be amended to read the Department of Public Health “shall” adopt regulations rather than “may”.
Brooke H. Kokus, Asian Studies Academy Health Center: Children are kept out of the emergency departments simply by addressing illnesses sooner and stopping the spread of disease. Providing treatment and monitoring of chronic conditions helps keep children in the classroom. Routine physicals and immunizations provided in the clinics prevent outbreaks and the spread of disease.
Improved attendance is a direct correlation to improved graduation rates which leads to more productive members of a community.
JoAnn Eaccarino, Associate Director, Child and Family Agency: The bill is not meant to diminish the importance of those that offer only physical or only behavioral health care, but to provide clarity for everyone. We want to make clear that a School-Based Health Center (SBHC) is comprehensive and incorporates both services that support care for the whole child.
For years Connecticut has been recognized nationally as the gold standard for their SBHC. Our grants dating back from the Department of Public Health have always been expected that a SBHC would offer both physical and behavioral health care.
NATURE AND SOURCES OF OPPOSITION:
Susan Israel, M.D.: She expressed concerns having a child's entire medical record accessible to the school system, how data is stored, and whether the record would be scrubbed from the school data system when the child leaves the school. Once information is in an electric medical record, it will follow a person through life with possible negative consequences for employment, school, and military applications. The protection of a child's privacy for their future should be of utmost importance as this bill moves forward.
Since 2002, according to HIPAA, hundreds of authorized people can see a medical record without patient consent or knowledge.
Reported by: Lori Littmann