Comprehensive School-Based Health Clinic Program RFP Q&A

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The Urban Health Program, Department of Pediatrics at the Emory University School of Medicine is requesting proposals to stimulate planning, and to facilitate collaboration and community discussion to expand the number of school-based health clinics throughout the state from two to 12 within five years.

Proposals are due April 26 at 5 p.m. The Urban Health Program will award 10-12 grants each year for the next three to four years. This year’s funding will begin July 1.

Dr. Veda Johnson, Carolyn Aidman, and Ruth Ellis of the Program hosted a statewide telephone conference last month to discuss the request for proposals. Here are their responses to the questions they received.

Did Emory University develop the school-based health clinic model at Whitefoord Elementary and Coan Middle School?
The model was developed in Texas and Minnesota during the 1970s. We adopted the basic model at Emory University’s Department of Pediatrics in 1994 and revised it based on the needs of children and their families in Georgia. Today there are 2,000 school-based health clinics across the United States, with two in Georgia.

How did you approach the governing agencies to get approval for your clinics?
We first met with school-system officials (principal, superintendant, school health services) to educate them on the merits of providing health services to children at school. Then we met with the PTA and other parents, and later gained support from local and state legislators to help influence community members.

What is Urban Health Center’s availability in providing technical assistance?
We can provide a wide range of technical assistance and will respond to questions during the Request-for-Proposal process and throughout the term of the grant. We’re available for conference calls and site visits, and we will host tours at the Whitefoord Elementary and Coan Middle School clinics. We can facilitate meetings, meet with potential providers, and assist with educating school and local officials, and political leaders. The Emory University Office of Community Partnerships can provide student support for data collection, needs assessment and focus groups.

Who staffs these health clinics?
The basic core model includes medical service providers (physician, advanced nurse practitioner, and physician’s assistant), front office/back office staff, and a social worker.

Will our volunteer medical providers have a role?
Because school-based clinics are designed to be true medical homes, it is best to have a salaried physician or nurse practitioner with back-up professionals.

How can schools attract local physicians’ interest?
The school provides the physical space for the facility, utilities, and patients.  The school may provide the school nurse, the school social worker, and additional education professionals.  Other services (i.e. custodial) may be offered.

What is the school nurse’s role?
The school nurse serves as the facilitator between the school health program and the clinic staff, and helps define the school clinic’s services and structure. The school nurse’s duties extend beyond routine school health mandates—conducting vision, hearing, and scoliosis screenings; monitoring student health information; administering medication; routine medical triage; and writing referrals—to include coordinating comprehensive student health care within the clinic facility.

 How can this approach work when a lead nurse rotates between five schools?
Identify a centrally located school where you will establish your first comprehensive school-based health clinic. Name a medical provider and have the school nurse participate in the care. The school nurse can coordinate access and refer students from schools without a school clinic into the school-based clinic.

What are the barriers for parents who want to get quality health care for their children?
Cost, transportation, getting off of work to take children to the doctor, lack of information and knowledge about appropriate care, and lack of anticipatory guidance are significant concerns.  School-based clinics eliminate all these barriers.

What kind of parental consent for treatment is best?
We obtain blanket consent. We have a comprehensive open consent form that allows access to the child with or without the parent being present.  If we are going to do any kind of invasive procedure (immunizations, antibiotic injections, or lab draws) we always contact the parent. We try to get the parents to come in when their children are being seen, and if they can’t we communicate by telephone or lecture. We always call and communicate with parents to discuss medications, referrals, etc.

Does the school-based clinic serve students’ families?
That is a community/school decision. If access to the school is monitored and controlled, all family members can be seen. If the school is too accessible from the clinic, limit services to children at the school and their younger siblings. School clinics can offer extended or evening hours if there are concerns about unauthorized visitors entering the school when classes are in session.

Do your clinics provide well-child check-ups, anticipatory guidance, immunizations, treatment for chronic illnesses, referrals to specialists, prescriptions, population-based service, and dental services?
Yes. Behavioral health providers, health educators, dentists, social workers, nurses, and physicians of all levels can provide services in these comprehensive school-based health centers.

We have a high school that serves young parents and their children. Can we serve these young parents and their children in a school-based health clinic?
You can serve a student’s entire family. It is essential to determine the services you want to offer. Only 15 percent of visits by adolescents are for reproductive health issues. The community must agree to any family planning services ahead of time to avoid controversy. If your community doesn’t support reproductive health services in the school clinic, don’t force the issue.

How do you prevent appointment overload and walk-ins?
Structure your day with appointments, allowing flexibility to serve walk-ins. The Urban Health Center will provide individualized technical assistance if needed.

Are services available on weekends and during vacations?
The two school-based clinics in Atlanta, established as medical homes, are open to the students year-round with after-hours coverage through Emory University. School clinics with limited resources close during school holidays and summer.

How are payments for services handled?
It depends on your partner. Community Health Centers and doctors can bill at their regular rates. You can bill Medicaid and PeachCare, private health insurers, or self-pay at a sliding scale. No patients should be denied services based on their inability to pay. The Urban Health Program will help you work through billing options.

How can we locate funds and support?
Initiate partnerships with Federally Qualified Health Centers (FQHCs) and local hospitals that may view school-based clinics as a solution to the high cost of inappropriate utilization of emergency rooms. Reach out to other health providers and systems that are concerned about providing quality health care to the indigent and uninsured children in the community.

What are the benefits to collaborating with FQHCs?
FQHCs have access to federal funding and can provide health services to students’ family members at their main facility. In turn, school-based clinics help FQHCs extend their care into the community, which is a priority for FQHCs. We will sponsor workshops that can facilitate collaboration between school districts and FQHCs. 

Is there any active legislation regarding funding for school-based health care?
The House voted 219 to 212 on March 21 to pass the Senate’s Patient Protection and Affordable Care Act (HR 3590). The Senate bill includes two important provisions for school-based health centers (SBHCs): language authorizing a federal SBHC grant program that would provide $50 million over five years, and an emergency appropriation that would provide $200 million for SBHCs over two years.  For more information visit the National Assembly on School-Based Health Care Web site.

Will Georgia receive any funds for development or sustainability?
Probably not, though the Georgia Department of Behavioral Health & Developmental Disabilities may be able to collaborate and provide behavioral health services. The Division of Public Health also may be able to provide a full array of dental services and health educators to a partner.  In the current economic environment it’s more productive to partner with FQHCs, local hospitals, teaching hospitals, and local physicians with robust practices that already serve the indigent and uninsured.

Can you provide a sample budget for the grants?
You can request a sample budget from Ruth Ellis at [email protected]. Because these are planning grants, funds are not available for medical or administrative personnel, space renovation, equipment, or medical supplies. Mileage reimbursement is .50 per mile.

Find an FQHC in your area.

Get general FQHC information.

Download the request for proposals.

Download grant application form.

To learn more about the award, read Emory University School of Medicine’s news release.

Contact:
Ruth Ellis,
Business Administrator
Urban Health Program, Department of Pediatrics
Emory University School of Medicine
[email protected]

William Valladares
Communications Coordinator

404-527-7394 (x114)

[email protected]