State to Change School Medi-Cal Billing Program

We have very exciting news to share about the “free care rule” reversal that reopens a critical avenue of reimbursement for Local Education Agency (LEA) school health providers.

Learn More About the Free Care Rule

The Department of Health Care Services (DHCS) announced on August 29 that changes to the provider manual for the LEA Billing Option Program will reflect the most recent policy direction from the Centers for Medicare & Medicaid Services (CMS) regarding “free care.” The draft changes to the manual are available for review and should be officially published later in September.

This exciting anticipated change to the LEA Billing Option program ensures that Medi-Cal may reimburse LEA providers for services provided to Medi-Cal eligible students, even if they are not in special education.

We hope that everyone providing health services in schools will learn about this opportunity to draw down more revenue to create robust school health systems that include both school districts and community providers.

You can learn more about the “free care” policy, the LEA Billing Option program, and CMS’s policy change on our Free Care Rule page. We have been working closely with DHCS, LEAs, the California School Nurses Organization, and other advocates to make sure that our state makes changes to the LEA program to strengthen school-based health care.

Judy Appel Named Executive Director

Judy AppelThe California School-Based Health Alliance Board of Directors has named Judy Appel as the new executive director to lead our organization.

Judy starts on September 19 and is excited to join us at a moment of incredible opportunity to build more support for school-based health care. Our Board of Directors chose Judy after a comprehensive search process because of her strong experience leading a regional nonprofit to statewide and national prominence.

Judy has served since 2005 as the executive director of Our Family Coalition, which is based in the Bay Area and advances equity for lesbian, gay, bisexual, transgender, and queer (LGBTQ) families with children through support, education, and advocacy.

She has led policy victories for Our Family Coalition, including the Welcoming and Inclusive Schools Program that guides schools to create more welcoming environments for LGBTQ families, and LGBTQ inclusion in the new history-social science curriculum framework recently adopted by the State Board of Education. She is also involved in statewide policy efforts on ending the school-to-prison pipeline.

Judy serves on the Board of Education for the Berkeley Unified School District, where she oversees a complex budget of $135 million; guides policy direction for instruction and programs; supports physical and mental health services for students; and leads Board efforts to implement restorative justice, social emotional learning, and trauma-informed practices at school sites.

In addition, she is involved with numerous initiatives aimed at improving education and health equity for all students, including the Restorative Practices Advisory Committee, the Berkeley Unified 2020 Vision Leadership Team, and the Fix School Discipline Policy Coalition.

We are pleased to welcome Judy as we begin a new phase of growth for the California School-Based Health Alliance and school-based health care in California!

How Supreme Court Ruling Affects Health for All Kids

Health4AllKids-HHH-SBHCs-largeThe United States Supreme Court on June 23, 2016, issued a 4-4 split decision on President Obama’s executive immigration actions known as Deferred Action for Parental Accountability (DAPA) and the expansion of Deferred Action for Childhood Arrivals (DACA).

This leaves in place a lower court decision that blocks the implementation of these executive orders.You can read more about what this ruling means by reading statements from The California Endowment and the National Immigration Law Center.

School-based health centers have always been committed to providing health care for all students, regardless of immigration status. The California School-Based Health Alliance stands behind the work that all of you do to keep everyone in our state healthy and ready to learn. We will continue to advocate for health security for all children and families in California.

Today’s ruling does not affect the 2012 DACA program or California’s recent Medi-Cal expansion to undocumented children. We continue to ask schools and school-based health care partners to join us in sharing information on Medi-Cal for all kids in California.

  • You can download customizable flyers that you can print or post on your school’s website here. These flyers meet the state’s requirements for AB 2706, which requires schools to include information about health coverage at registration.
  • You can get more information and resources here.

You can see our health coverage outreach resources here.



A Note on Violence Affecting Bay Area Youth

By Juan Taizan

health-center-graffiti-450In the last two weeks three young men have been murdered in Richmond in the Bay Area. Xavier Mclanahan, 14, Malik Barnes, 15, and Joshmahl Russell, 21, were all shot to death, their lives ending far too soon.

While we did not know these young men directly, they were a part of our community through the school-based health centers and partners we know in Richmond. Their deaths also touch a nerve because of our work to support young men of color who have experienced violence.

I can’t help but feel frustration as I struggle with the question of what more any of us could have done to prevent these tragedies. It also makes me feel overwhelmed at how much more work we have to do to prevent future violence and death. It is important for us to take some time to pause, to reflect on the lives of these young men, to understand the pain of their loss, to feel the joy they brought to their friends and families, and to envision the lives they could have lived if they had more support and opportunity.

It is important that we take all of our feelings and remember this is why we do our work. School health staff regularly support young men and women who face the same challenges of Xavier, Malik, and Joshmahl. SBHCs and school health services play an important role in not only helping youth be healthy and succeed; they help many youth stay alive.

We have to continue to advocate for school health. We have to continue to find resources to help every young person who needs support. We have to continue working to honor the lives of every young person we have lost and to honor Xavier, Malik, and Joshmahl.

You can read more about Juan’s experiences helping students and schools through school-based health on the CSBA blog: Invest in Health to Improve School Climate & Student Engagement (Omar’s Story).

New Voices Bring Promise to Childhood Adversity Challenge

By Serena Clayton

This post originally appeared on The Chronicle of Social Change.

At the Center for Youth Wellness policy convening on childhood adversity recently, I kept asking myself if we were having a new conversation or an old conversation but with different people at the table.

The fact that children who experience adverse events (e.g., domestic violence, or a mentally ill or incarcerated parent) have worse health outcomes hardly seems like news. In public health, we know that environmental, economic, and social factors lead to health disparities. In education, we know that poverty is connected to lower achievement, and there is a strong correlation between poverty and adverse childhood experiences (ACEs).

To address ACEs, new “trauma-informed practices” are moving the focus off of “fixing” individuals to understanding their experiences and building resiliency and safe, supportive environments. All of this sounds a lot like youth development, protective factors, and strength-based approaches.

There is no doubt that we are seeing some of the same ideas come back in a new package. But something is different now, and it is the very fact that different people are at the table. The concept of childhood trauma has succeeded in uniting various sectors in a way that I have not seen before.

Juvenile and criminal justice advocates see themselves in this issue because so many youth who have experienced trauma end up in the correctional system. Educators have a stake because childhood trauma shows up in the classroom in the form of poor attendance, behavioral challenges, or learning difficulties.

Even the health care industry is beginning to take note. We now have not only epidemiological evidence of the impact of social stressors on health, but also biological evidence. ACEs or chronic stress raise the level of cortisol in the body which affects many physiological processes and, ultimately, increases the risk of poor health outcomes. Just like poor diet or physical inactivity, ACEs are a risk factor that can to increased health care costs down the road.

As a public health professional with 20 years in various aspects of adolescent health, I am encouraged by the way that new science is creating new bedfellows. The concept of adverse childhood experiences provides an explanation for so many outcomes in different sectors: health disparities, the achievement gap, multi-generational poverty, cycles of violence.

As a school-based health advocate, I am intrigued by the possibilities. How can school-based health providers best use their unique position at the intersection of health and education to respond to childhood adversity, or to prevent it in the first place? As health care (slowly) begins to take prevention more seriously, what approaches to childhood trauma could become part of pediatric care or patient-centered health homes?

As educators strive to improve school climate, what alternatives to suspension will become standard practice? How can the public health and educator sectors support criminal justice reform as a health issue? And how can justice reform advocates help increase resources for health and education?

Thank you to the Center for Youth Wellness for a thought-provoking day. I look forward to our next steps!

Serena Clayton is the Executive Director of the California School-Based Health Alliance.

Safety, Justice, Equity, & Our Work in School-Based Health

By Serena Clayton

This post originally appeared on the Voices for Health Equity blog.

On November 4, 2015, I attended “Smart on Safety,” an invitational summit to examine how California can reform the criminal justice system and transform communities to prioritize prevention over punishment.

As Adam Kruggel, Director of Organizing for PICO California, stated, “mass incarceration creates a legitimacy crisis for some of our most deeply held values – that everyone has a right to be a human being.” Harsh sentences, three strikes, mandatory minimums, racial profiling, gang injunctions, and transfer of juveniles to adult courts have demonized poor black and brown males as less deserving “others” – predators who are beyond redemption.

Anyone who works in marginalized communities knows the toll that these policies take on the health and life prospects of their teen patients. Although one would hope that the appalling scene in South Carolina is not the norm, it has been well documented that black students are three times more likely to be suspended than white students. Suspension is a gateway to dropout, economic instability, crime and incarceration. And we don’t need to look only at teens to see how “tough on crime” affects children’s health. Tamir Rice, a 12 year old who was playing with a toy gun in a park, is dead. The children of Eric Gardner and Walter Scott are fatherless. Approximately 2.7 million children have a parent in prison – a vastly disproportionate number of whom are poor and black. Millions more children experience post-traumatic stress disorder from extended exposure to violent encounters between citizens and law enforcement in their communities.

Speakers at Smart on Safety celebrated the one year anniversary of the passage of Prop 47, a huge step forward in turning the tide on mass incarceration. That this victory took place in California was significant. California has been among the states with the dubious distinction of leading the nation in mass incarceration. Prop 47 changed nine felonies to misdemeanors and gave thousands of low level offenders the opportunity to be resentenced, released, and have felonies wiped off their records. With this law, California takes on a new role as a leader in the national outcry against punitive policing and correctional policies that demonize communities of color.

As a professional from the worlds of health and education, I often felt like a fish out of water at this gathering of activists for social justice, racial equality, and criminal justice reform. But I appreciated the opportunity to attend and understand how our work in school-based health connects with this broader movement.

At this meeting schools were mentioned frequently as a key element in reversing our priorities so that we invest in prevention rather than in punishment. We heard calls for increased school funding, improved school climate, changes in school discipline, reduced school policing, and improved mental health services.

Jeff Rosen, Santa Clara’s district attorney, pointed out that many of today’s offenders were victims earlier in their lives. If we did a better job of attending to the needs of victims, might we have fewer offenders down the line? What school experiences would help children and families who have been victims of violence heal, stay engaged in school, and graduate?

School-based health centers have a critical role to play in this picture. They are part of a movement to transform education to encompass the support, the environment, and the services that students need to enable them to stay in class and concentrate on learning. For many students this includes approaches that address the trauma they experience as victims or witnesses to violence. I am proud that we are working with school-based health centers in Oakland and West Contra Costa specifically on this issue and hope that we can find more ways to strengthen the role of school-based health in promoting safety and justice.

Serena Clayton is the Executive Director of the California School-Based Health Alliance.

Health Access Grows for Students in CA

Hiram Johnson SBHC Opening

Students and faculty join CA Rep. Doris Matsui in celebrating the opening of the Hiram Johnson SBHC in Sacramento in March 2015.

School-based health care is growing in California and providing more services and health care access for students.  There are now 243 school-based health centers (SBHCs) providing high-quality health care to students. Across California, more than 257,000 students attend a school that has a health center, and many more have access to other types of school health services.

This is more than double the number a decade ago. Of the 243 SBHCs, 150 offer mental health care, 66 offer dental treatment, and 124 offer youth engagement programs that keep kids engaged in school and thinking about their future.

SBHCs are so popular because they offer convenient health care for kids in a setting families already know and trust.

Students who utilize SBHCs are less likely to go to the emergency room or be hospitalized, keeping costs down. SBHCs also improve attendance, reduce dropout rates, improve school climate, and support students’ academic achievement. Schools and school districts partner with health service providers to finance SBHCs.

More Information on California’s SBHCs

There are 243 SBHCs serving 257,000 students across California. SBHCs are usually located directly on a school campus and provide primary care like any health clinic. Staff vary in size, and typically includes nurse practitioners, nurses, mental health providers, as well as part-time physicians and medical students. Services are provided at no or low cost. No one is refused service for inability to pay.

Services Offered

Service Number Percentage
Medical 209
Health Education 172 71%
Mental Health
150 62%
Reproductive Health – Screening & Education
146 60%
Reproductive Health – Clinical Care 136 56%
Youth Engagement 124
Dental Prevention 118
Dental Treatment


Sponsoring Org Types

Type of Sponsoring Organization Number Percentage
Community Clinic 131 54% 
School District 69 28% 
Local Health Department 11 5%
Hospital 10
Nonprofit Organization 8
Mental Health Agency 8
University,  Including Medical Center 1
Tribal Government 1 .4%
Other 4 2%


Onsite SBHC Location Level 

School Level Number Percentage
High School 115 47%
Elementary School 62 26%
Middle School 26 11%
Other (school-linked/mobile/combined levels) 40 16%



AG’s Report Raises Alarm on Poor Elementary School Attendance

Attorney General Kamala Harris raises awareness about poor elementary school attendance in California and calls for action.

Attorney General Truancy Report #EveryKidCountsWhen students are chronically absent from elementary school, they fall behind academically, they are less likely to graduate from high school, and they are more likely to be unemployed and on public assistance. Putting kids on a path to success requires attention to student attendance, particularly in the early years. Research shows that early school attendance is a critical building block to a child’s success.

Read more about the causes of chronic absence.

Attorney General Kamala D. Harris has made reducing elementary school truancy and chronic absence a priority. As part of this effort, the Attorney General released an annual report, In School + On Track, to disseminate effective practices for reducing student absences, to track changes in statewide attendance rates, to raise awareness about the critical importance of elementary school attendance, and to call others to action.

The 2015 report includes new and updated data on the still alarming rates of elementary school truancy and chronic absence across the state.

  • More than 1 in 5 elementary school students in California are truant based on data from the California Department of Education.
  • An estimate of 8% of elementary school students in California are chronically absent. That means over 230,000 of our youngest students are already at risk of falling behind in school.
  • Data also shows that there are disproportionately high rates of absenteeism and suspensions for students of color, low-income, homeless, foster youth and special education students.

There is also a positive trend across California: increased attention and more concerted efforts to improve elementary school attendance. The 2015 report highlights some of the districts and counties engaged in this important work.

The California School-Based Health Alliance applauds the Attorney General for continuing to draw attention to the issue of chronic absence in California. We know SBHCs make a huge difference at the schools they serve in addressing the underlying health issues that may impact attendance. Check out some of the ways that SBHCs are making a difference.

“School-based health providers across the state have firsthand experience with both the causes and consequences of chronic absence. Economic inequities prevent many children from getting the health, mental health, and dental care they need, which leads to untreated health problems that keep kids out of class. School-based health centers are an important part of a comprehensive solution to improving attendance, advancing equity, and closing the achievement gap.” 
– Serena Clayton, Ph.D., Executive Director, the California School-Based Health Alliance

$2 Million Grant to Help Address Trauma in Oakland


Serena Clayton, Executive Director of CSHA, and Fred Blackwell, CEO of The San Francisco Foundation, at the grant announcement in Oakland.

The California School-Based Health Alliance (CSHA) received a $2 million grant July 14 from The San Francisco Foundation to support trauma-informed care in 15 school-based health centers in Oakland Public Schools.

CSHA is one of 17 Oakland-based nonprofit community-based organizations receiving funding as part of a $34 million gift made to The San Francisco Foundation from an anonymous donor in 2015. Read more about the anonymous gift.

“For young people who grow up in communities where violence and instability are a way of life, trauma can have a profound impact on motivation, school performance, and life options. Trauma results from, and contributes to, the glaring social inequities that face our communities,” said Dr. Serena Clayton, Executive Director of CSHA.

“We are grateful to the San Francisco Foundation and its donor for their confidence in us and in the potential of school-based health centers to achieve transformational change in the lives of young people,” said Clayton.

The grant will enable CSHA to build supportive environments and services to help students cope with high levels of trauma. CSHA will be engaging school-based health centers in implementing schoolwide screenings, support groups, trauma-informed care, and support for teachers.

Click to expand map

Click to expand a map of the impact this grant will have on Oakland Schools.

School-based health centers bring medical and mental health professionals directly on to school campuses where they are in close proximity to both students and school staff. This proximity leads to unique opportunities for teachers, students, families, and medical and mental health providers to work together.

CSHA will share lessons learned throughout California and nationally.

CSHA’s partners include the following:

Seven Supporting Agencies

East Bay Agency for Children
East Bay Asian Youth Center
Fred Finch Youth Center
La Clinica de la Raza
LifeLong Medical Care
Native American Health Center
UCSF Benioff Children’s Hospital of Oakland

Fifteen School-Based Health Centers

Frick Middle School-Based Health Center
Shop 55 Wellness Center-Oakland High School
Rising Harte Wellness Center-Bret Harte Middle School
Fremont High School Tiger Clinic
Havenscourt Health Center-Coliseum College Preparatory Academy
Hawthorne Health Center-Urban Promise Academy
Roosevelt Middle School Health Center
TechniClinic-Oakland Technical High School
Elmhurst/Alliance Middle School Wellness Center
West Oakland Middle School Health Center
Madison Park Business and Art Academy Health Center
Seven Generations School-Based Health Center-Skyline High School
Seven Generations School-Based Health Center-United for Success/Life Academy
Chappell Hayes Health Center-McClymonds High School
Youth Uprising/Castlemont Health Center-Castlemont High School

National Task Force Recommends SBHCs for Equity

West Oakland Middle School Health ClinicThe national Community Preventive Services Task Force has recommended school-based health centers in low-income communities as an effective service to improve educational outcomes including school performance, grade promotion, and high school completion.

Public Statement | Detailed Finding

School-based health centers are also recommended because they provide low-income and minority students with health care and health education that gives them a chance to stay in school and perform better academically, which can lift whole communities.

In a statement accompanying the recommendation, the Task Force said:

“Children from low-income and racial and ethnic minority populations commonly experience worse health, are less likely to have a usual place of health care, and miss more days of school because of illness than do children from the less economically and socially disadvantaged populations.

“Addressing these obstacles can be critical to their education and long term health.”

The Task Force recommendation is based on a review of 46 studies on school-based health centers and their impact on health and education.

Education outcomes include:

  • School performance
  • Grade promotion
  • High school completion

Health outcomes include:

  • Delivery of vaccinations
  • Other recommended preventive services
  • Asthma morbidity
  • Emergency department and hospital admission
  • Contraceptive use among females
  • Prenatal care and birth weight
  • Other health risks

The Community Preventive Services Task Force (Task Force) is an independent, nonfederal, unpaid panel of public health and prevention experts that provides evidence-based findings and recommendations about community preventive services, programs, and policies to improve health. Task Force members are appointed by the Director of the Centers for Disease Control and Prevention (CDC).