A Letter from the School Nurse

Too often I see children in my office in need of help that is not easily available to them. I see students with medical and dental needs including broken bones and abscessed teeth. Currently students without insurance are forced to go out of town for the care they receive. Most of them must go to the emergency department at the closest hospital where they may end up waiting for hours before they are seen. We have students with obviously sprained ankles that do not have a care provider to write them a simple excuse from PE, as required by state law, so that they do not get marked down for not participating.

One option for families is Oregon Health Plan which currently has thousands of families on the waiting list for coverage. What do they do in the meantime? Families that are on Oregon Health Plan find road blocks with Doctor and Dental Clinics that will not accept their insurance. I saw a young boy in my office with an abscess tooth that had an appointment one month out to have the tooth looked at. This tooth was severely infected and needed to be pulled immediately. I ended up finding a local dentist that was willing to pull the tooth for free.

Columbia County has the highest un-employment rate in the state and a poor socio-economic population. Rainier School District mirrors that with 43% of our students on free/reduced lunches. These students are attending an aging school facility, in a rural setting, void of any hospital or local physician.

We are a town, school, and community with limited resources available to help the children with socioeconomic challenges. Your support with allow us to make an impact on our medically under or uninsured population.

Your support of a School Based Health Clinic on the Rainier School District campus will help to offer our students a resource that will treat their health needs, keep students in school and increase actual seat time in classroom. We hope that this will start a ripple that will bring more health care to our community. Please join me in supporting this great opportunity and wonderful endeavor.

Laurie A. Womack RN, BSN

Rainier School District Nurse

503 556-4215 x223

Rainier SBHC Planning Committee

Mission:

Our mission is to provide a sustainable and thriving health center on the Rainier School District Campus to improve medical access and promote education.

Vision:

We will use community partnerships to provide acute, primary, and preventive health services for all students.  In addition, we recognize the need for primary care services for citizens of Rainier and will strive to expand the school-based health center to provide those services.

Please direct any questions to Aisha Krebs, Public Health SBHC Coordinator. She can be reached at 503-397-4651 x206 or apoole@chdpublichealth.com

Contact information for all Rainier SBHC planning committee members is available on the Rainier School District website: www.rainier.k12.or.us under Parent Resources.

Why School-Based Health Care Works

ACCESS...     

68 percent of Oregon students seen in an SBHC reported that they would not have received health services that day without their center.*

• The child may lack medical insurance.

• The insurance policy of working parents may not cover their children or may only provide for catastrophic illness.

• Transportation challenges, especially in rural areas.

• The community may lack a medical provider or one who will accept the Oregon Health Plan.

• Out of pocket health care costs are beyond the means of many families.

• School-based health centers break down these barriers by providing students with the care they need, regardless of their family's insurance status or ability to pay. SBHCs are conveniently located in a familiar environment where students spend much of their day.

PREVENTION...

85 percent of students reported that they received at least one prevention message when visiting their health center.*

SBHCs counsel students individually, in groups, and through school-wide education initiatives. What are some of the health messages SBHCs provide?

• Tobacco and drug prevention

• Healthy eating/obesity counseling

• Exercise

• Emotional health

• Screening for chronic diseases such as asthma and diabetes

School-based health centers are prevention-focused so that health problems and risky behaviors can be caught early or prevented altogether. Prevention and early intervention make financial sense by reducing inappropriate emergency room use. But most importantly, prevention keeps kids healthy so that they can succeed in school.

SCHOOL SUCCESS...

In Oregon, 68 percent of students reported that they would have missed at least one class to receive care outside their health center.*

Studies show that school-based health centers decrease absenteeism, tardiness and school discipline problems. Because many children can be treated at school for their health care needs, daily attendance is increased - providing the school with maximum revenue. One elementary school in Oregon reported a 65% decline in discipline referrals for students who were seen by an SBHC mental health therapist.

Facts About SBHCs In Oregon—Oregon's Challenge

• 12% of all Oregon children are uninsured

• 45% of SBHC clients are uninsured

A Resource in Our Communities

• Oregon has 45 certified SBHCs in 19 counties with 18 additional centers in planning stages of certification for 2009.

• In 2006-2007, Oregon SBHCs served 20,831 clients with 69,043 visits.

• SBHCs deliver a core set of medical and mental health primary care services, as well as preventive health services.

• SBHCs are staffed by licensed

• health professionals, including nurse practitioners, physician assistants, registered nurses, and qualified mental health counselors.

Cost Effective - A Smart Investment in Kids

• In 2006-2007, the state of Oregon contributed $1.37 million to SBHCs which supported the delivery of over $2.6 million in health care services.*

• A study by Johns Hopkins found that SBHCs reduced inappropriate emergency room use among regular users of school-based health centers.

• 2008 Status Report on School-Based Health Centers, State SBHC Program Office

What is a school-based health center (SBHC)?

School-based health centers are like a doctor's office in school. They provide quality primary and mental health services where kids are - keeping them healthier, in school and ready to learn.

What services are offered in an SBHC?

• The centers provide quality primary health care, including routine physical exams, diagnosis and treatment of acute and chronic illness, treatment of minor injuries, and vision and dental screenings.

• They provide prevention messages and health education such as obesity counseling and tobacco prevention.

• They provide or connect students with mental health services, including grief therapy, help with peer pressure, bullying and suicide prevention.

• Most SBHCs offer services to all students within their district and some offer expanded after-school hours.

• Many SBHCs engage students, parents and community members in advisory councils that provide support for the center and opportunities for community service.

How are SBHC services decided?

The decision on which services to offer at an SBHC is a local-level decision in complience with state certification standards.

How are SBHC services funded?

Funding mixes vary by site but include state dollars sent to each county with an SBHC. In 2007·2009, state funding for SBHCs is approximately $5 million. Local dollars may come through billing and reimbursement, school districts, county health departments, hospitals, local businesses and individuals, grants and other fundraising.

Planning Efforts Begin for a Rainier School-Based Health Center

The Clatskanie Chief

January 31, 2008

by Ruth E. Howard

By spring 2009, Rainier School District could have a certified health center on its campus, available to Rainier's students, and perhaps someday to serve school staff and other community members.

What a school-based health center (SBHC) in Rainier would offer, who it would serve and how it would be funded are among the questions being tackled by a planning committee during a current planning phase that ends June 30.

Rainier School District administration and other school personnel, parents, local citizens, a Rainier Junior/Senior High School student, and representatives from Columbia Health District-Public Health Authority, Northwest Regional Education Service District and Columbia Community Mental Health were among those who met Thursday, Jan. 24, for an initial planning meeting to hear more about Oregon's school based health centers and what steps lie ahead for Rainier to have its own center.

"Health care where the kids are is the mantra," said Aisha Krebs, school-based health center program coordinator with Columbia Health District (CHO), which is overseeing

the planning effort.

Providing access to services and "allowing students responsibility for their own healthcare," are among the focuses of SBHCs, Krebs told the group.

According to DHS, qualified nurse practitioners, physician assistants, registered nurses and counselors at the SBHCs provide comprehensive physical, mental and preventative health care to school-age children, whether or not they are insured or able to pay. A center's "umbrella" can also include health education and promotion.

Rainier's current planning phase, which runs through June 30, is funded by a $30,000 Department of Human Services (DHS) grant, one of three recently received by CHD. In addition to Rainier, the Vernonia and St. Helens school districts are seeking high school-based centers.

St. Helens' Sacajawea Health Center at Lewis and Clark Elementary School is one of 45 established SBHCs in Oregon.

"Currently the community does not have medical services," commented district nurse Laurie Womack at the Jan. 24th meeting.

While Rainier does have dental clinics and a local chiropractor who provides physical examinations for student athletes, other treatment is often referred to providers outside of Rainier, said Womack, requiring parents to miss work or make other arrangements.

"There is significant clientele who don't know how to access services," concurred Hudson Park Elementary School Principal Russ Pickett, stressing the need for a referral system to be included in the center's scope.

Providing referrals, as well as offering on-site care so students can be treated earlier and thus return to school sooner, were also emphasized at last week's meeting.

According to DHS, the centers address other "barriers" to adolescent health care such as inconvenience, cost, transportation, confidentiality concerns and students' apprehensions in discussing personal health problems.

"I wholeheartedly know the need is here," said Superintendent Michael Carter, referring to Rainier's results in the 2007 Oregon Healthy Teens Survey, conducted by DHS among the state's eighth and 11th grade students.

The "disparity of services" shown in the survey was the reason Rainier received the grant, said Krebs.

The voluntary survey revealed that only about half of the local students had a health check-up in the previous 12 months, slightly above the state's 47.3 percent average for eighth graders and below the state's 55.1 percent norm for 11th grade students.

Questions about substance abuse, victimization and harmful behavior, harassment, mental health, sexual activity, injury prevention, and weight, nutrition and physical activity were also included in the survey. For more information about Rainier's results, contact the district office at 503-556-3777.

As the planning moves forward, the committee and various subcommittees will look into location of the center, what services to offer and to whom; engaging community partners, including medical providers; determining the school district's level of involvement, and identifying funding sources, among other necessary details.

While some state and federal funds are available, future state monies will be divided among the county's centers, and for every $1 a clinic receives from the state, another $3-4 needs to be generated, said Krebs.

Other funding sources, such as grants, fundraisers and assistance from foundations, will be explored in the coming months.

Rainier's next SBHC committee meeting is set Tuesday, Feb. 5, at 12 noon, in the Rainier School District board room, 28168 Old Rainier Road. The meeting is open to the public.

Informing the community about SBHCs and the ongoing process is important, said Krebs, who offered to speak to any interested community groups. She may be reached at 503-397-4651.

At the end of the first planning phase, a committee-developed strategic plan will be submitted by Krebs to the state in late-June, serving as an application for a second round of planning funds.

The next planning phase would conclude in February 2009. If it is decided to proceed with the SBHC, Rainier students could have access to school-based health services later that year.