Ensuring Utilization of the School-Based Health Center
What’s the best way to get students registered with your SBHC?
Most health care providers prefer written parent or legal guardian consent before they will see a student for general medical care. While you can try sending consents and medical history forms home for parental completion, very few will students will get registered this way. Many SBHCs do outreach and have parents/guardians complete the forms at in-person school registration, back-to-school nights or open houses, and any other school events that families are likely to attend. Work within your own and school staff to identify interpreters who can help families complete the forms in their native language. Raffles or other incentives for those that complete registration forms are always fun!
Should you register students for whom you are not the primary care provider?
The philosophy and spirit of school-based health care is to serve all students on campus. We strongly encourage you to register all students who are interested, as their families may choose for them to wellbecome your “assigned” patients under managed care as a result of your presence in their school community. In addition, many students may not yet be enrolled in Medi-Cal or health insurance, or they may need to be re-enrolled. In either case, you may become their selected primary care provider if you demonstrate an “open door” policy for all students. That said, some SBHCs will only provide limited services to students who are well-established with another primary care provider. These services might include immunizations, urgent care, acute exacerbation of chronic illness, and sometimes management of a condition requiring daily treatment at school, such as asthma or insulin-dependent diabetes. In all cases, it is essential to coordinate care with the primary care and/or any specialty care providers of your SBHC patients.
Do students need to have parental permission to be seen at an SBHC?
For a student to be seen at an SBHC for general medical care, a parent or legal guardian must give consent. However, under California law, children of any age can receive emergency medical care and pregnancy related services without parental consent. Students 12 years and over may receive additional services without parent/guardian consent, including prevention and treatment for STDs, HIV counseling and testing, outpatient mental health services, substance abuse treatment, and rape services. All students receiving these services get counseling, which includes guidance on discussing health concerns with parents and guardians whenever it is appropriate and safe to do so.
Should you provide school staff services at the SBHC?
As SBHCs decide whether to offer services to school staff, they consider issues such as their ability to bill health insurance carriers for services provided, and the need to ensure student privacy. Since school staff usually have health insurance and an assigned primary care provider outside the SBHC, most SBHCs provide limited or no clinical services to staff. Common staff services include flu vaccines, TB tests, and minor first aid. Some SBHCs also promote staff wellness through health education, healthy snacks at staff events, or even yoga classes.
In the event of an emergency, SBHC staff should respond to all people in the building. School administrators are encouraged to include SBHC staff in their school safety planning, on their health and safety committees, and as part of their response team. In addition, the SBHC should serve school staff as an expert source of health information and consultation related to student health issues.
Can community members receive services at the SBHC?
Some SBHCs offer services to students’ family members, or even to the community at large. As SBHCs decide whether to offer services to community members, they consider a range of factors, including, but not limited to: the security arrangements in the school; your agency’s ability to bill health insurance carriers for services provided; and the expressed desires of the students, school, and local community. If an SBHC is open to the community, it is critical that systems are in place to ensure adolescents’ confidentiality and privacy. Often, SBHCs serving community members have two entrances—once inside and one exterior to the school.
Integrating the SBHC into the School
What is the difference between SBHC staff and school clinical staff?
School clinical staff, including school nurses, school psychologists, and school social workers, are school district employees, and their work is governed by the California Education Code, the California Health and Safety Code, and the federal Individuals with Disabilities Education Act (IDEA). Their primary responsibility is to provide a core set of mandated school health services, which include hearing, vision, and scoliosis screenings, as well as health-related special education services. School nurses can provide first aid, as well as dispense or administer prescription medications with orders from the primary care provider, but they cannot diagnose conditions or write prescriptions.
Both school clinical staff and SBHC staff contribute to student health, academic success, and overall well-being, but they do play distinct roles. Clear written policies outlining position-specific responsibilities are helpful in ensuring the best possible partnerships. That said, and as always, the more collaboration the better! To this end, policies should include thoughtful communication systems and jointly determined collaboration norms.
Can students visit the SBHC during class time?
SBHCs are focused on supporting student success in school, which means addressing absenteeism and minimizing missed classes. Every effort is made to schedule SBHC appointments so that students do not miss core classes. In the rare instances when students do need to miss class for appointments, school and SBHC staff work together to create a schedule that poses the fewest problems for students and teachers.
What information can school staff and SBHC staff share with each other?
Educational information is protected by the Family Educational Rights and Privacy Act (FERPA), while health information is protected by the Health Insurance Portability and Accountability Act (HIPAA). These two pieces of federal legislation are extremely complicated and extremely important. Comprehensive guidance can be found on CSHC’s Consent and Confidentiality webpage.
In brief, school district employees, including school nurses, cannot share most individual student record information with SBHC staff not employed by the school district (under most circumstances), unless they have parent/guardian authorization allowing them to do so. Schools may ask parents/guardians to complete an “authorization for release of information” to the SBHC so the school can share relevant student health, attendance, and/or academic data. This will allow the SBHC to better serve students’ health and academic needs in partnership with the school. SBHC staff employed by the district may share health information with other district employees, if they determine these staff have a “legitimate educational interest” in the student’s health information.
SBHC staff not employed by the school, on the other hand, cannot share students’ health record information with school staff without parent/guardian consent (or, for minor consent services, without student consent). This means that even if a teacher refers a student to the SBHC, the SBHC staff cannot report back to the teacher on the student’s condition, diagnosis, or treatment plan. Again, SBHCs can solicit permission from students, parents, or guardians to allow them to share health information with school staff if appropriate. Doing so can often be helpful in ensuring that students’ holistic needs are being met, through a diverse set of supports.
Regardless of sponsoring agency, SBHC staff can always provide school staff with general information and resources on relevant health issues and usage trends. In turn, school staff can freely share school-wide aggregated data on attendance, behavior and achievement.
What information can SBHC staff share with parents and guardians?
Under HIPAA, health information-sharing generally follows consent. SBHCs not run by the school district (operating under HIPAA) can share general medical information with parents and guardians, for all the services that the parent/guardian consented to. If the student consented to confidential services, including those services referred to in the section above on parental permission, then only the student can share the related health information with the parent/guardian. SBHC staff can, however, help foster improved communication between adolescent students and their family members, thus helping adolescents share their more personal health issues directly with their parents/guardians.
Under FERPA, different rules apply, as parents may access their child’s school records at anytime, including those health records created by school district-run SBHCs. This means that while minors may consent to certain services as outlined above, if the provider is employed by the district, the parent/guardian will have access to the minor’s records and may learn about “minor consent” services provided.