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School-Based Health Center Strategic Planning Steering Committee Meeting - Shared screen with speaker view
Susan Haberstroh DDOE
13:50
Good morning. On mute and will start video at 9am
Rosa Rivera
17:33
Good morning!
Dara Hall
17:47
Good morning!
Jon Cooper
20:56
Good morning, everyone!!!!
Susan Haberstroh DDOE
22:22
brb
Yvette Santiago
22:31
Good MORNING ALL!
Aileen Fink
24:07
Welcome and good morning!
Dr. Liz Brown (she/her)
24:38
Good morning—I’ll be off and on throughout the day, so Dara is here to make sure DMMA doesn’t miss anything.
Shelly Lazorchak
24:46
Good morning everyone!
Aileen Fink
25:57
Shout out to Drew!!!
Gloria James
26:39
From Gloria James - Woowoo, to Drew!
Kristin Dwyer, Delaware
26:40
Thank you to everyone at HMA for all your work! I am going to miss seeing Diana and Caitlin every week!
Cassandra Davis
26:57
Good morning.
Diana Rodin
26:58
We'll miss you too Kristin!
Caitlin Thomas-Henkel
27:22
Yes - we will miss seeing you Kristin!
Marihelen Barrett
41:03
All of the materials provided showed a great deal of work and a much thought about how to organize the information to help us be able to take all of the information in. A great job by DPH and HMA. Thank you for taking this effort on while dealing with so many other demands.
Aileen Fink
48:27
Was there any discussion of peer support as part of the behavioral health services approach?
Kristin Dwyer, Delaware
52:45
Can we have information on private/Medicaid/non-insured by county?
Yvette Santiago
53:58
Would like to learn more about the low usage of SBWC services in Kent County
Kristin Dwyer, Delaware
54:45
Does visiting 5 or more times a year impact academic performance?
Aileen Fink
55:05
is the usage low or is it that the representation in survey of students/caregivers from Kent Co. was low- sorry if I missed that clarification
Aileen Fink
56:03
Do we know what types of services are provided for those who get 5+- would assume it was behavioral health?
coneill
59:31
Increased use of WC actually improves academic performance by keeping students in school and using WC for support throughout the school day with referral out as needed for behavioral health
Frances A Russo-Avena
01:01:14
It would be interesting to obtain educators perspective on how having a SBWC that serves the healthcare needs of students can also impact overall wellness and academic performance of a classroom of students
Diana Rodin
01:02:47
Absolutely, Frances - in our interviews they were very interested in data that would get at that
Dr. Liz Brown (she/her)
01:04:20
?
Dr. Liz Brown (she/her)
01:04:30
Sorry, accident
Aileen Fink
01:05:36
For telehealth, is that finding consistent with the providers experience or an artifact of who was interviewed?
Kristin Dwyer, Delaware
01:08:00
Will we go over the focus group responses from educators?
Kristin Dwyer, Delaware
01:08:13
You can respond via chat
Kristin Dwyer, Delaware
01:08:21
no need to interrupt Jon
Diana Rodin
01:08:46
Kristin - not specifically, but we can pull out some of those findings to share separately
Kristin Dwyer, Delaware
01:09:06
Thank you Diana, that would be really helpful
Aileen Fink
01:09:44
Sincere appreciation for the work of HMA, the SC and workgroups- the information garnered is invaluable!
Marihelen Barrett
01:11:46
Agree - now is the time to move in a BIG way
Marihelen Barrett
01:12:54
Agree - Trauma Informed Care is a very important framework and initiative that SBHC can really advance
Yvette Santiago
01:14:17
under equitable... "need care/receive care"...when they need it. Important to note
Gloria James
01:16:43
From Gloria James - just a reminder that the future focus from the state will be to support expanding SBHCs to implement them in high needs elementary and middle schools.
Frances A Russo-Avena
01:17:11
Thank you Gloria!
Drew Hawkinson
01:20:11
We will restart at 10:15 AM EST.
Kristin Dwyer, Delaware
01:37:58
Does everyone know what a hub and spoke model is? Just want to make sure there is a common understanding
Jon Cooper
01:38:35
I agree that we should provide a brief definition of this term
Yvette Santiago
01:39:22
ditto
Leah.Woodall
01:43:31
integration, linkage and coordination with pc is essential
Leah.Woodall
01:47:08
I'm trying to understand incentivize....should we specifically call out explore reimbursement of CHWs to help with collaboration and coordination and referrals to community services
Frances A Russo-Avena
01:47:54
We also consider our students and families who are often transient from school to school and/or district to district due to housing insecurity. They often fall through the gaps in education and healthcare.
Kristin Dwyer, Delaware
01:48:59
I'm having trouble understanding this recommendation- as a non health policy person
Aileen Fink
01:50:28
Is part of what this is highlighting is that the care coordination between SBWC and community providers isn't something that is reimbursed?
Aileen Fink
01:52:09
I think Leah's point is important- determining what types of staff would best fill this role
Frances A Russo-Avena
01:52:17
Can school nurses be the bridge and coordinate services
Priscilla Mpasi
01:53:06
I agree with Leak
Kristin Dwyer, Delaware
01:53:24
Thank you Uma
Priscilla Mpasi
01:54:20
Is the payment incentive to the PCP or the SBWC or both? And based on RVU services or outcomes? Would discuss in breakout
Kathy Cannatelli
01:55:34
Ditto Leah’s comments
Dr. Liz Brown (she/her)
01:56:28
Happy to discuss more during the deliberation, but I think the only way this is doable would be voluntarily in the newly developed ACOs contracting with the MCOs.
Priscilla Mpasi
01:57:08
For this rec would the child travel to the siblings school to access the SBWC? This would then require the parent to transport the child to the other school. Why would the sibling not go to the PCP
Kristin Dwyer, Delaware
01:57:45
I think it will be important to explain why a SBHC cannot service families. These points were discussed in committee meetings. But I think it will be necessary for the public to understand why
Uma Ahluwalia
01:58:34
It could very well be that this recommendation does not get prioritized, which will be fine or it gets tweaked around CHW in a coordination role as opposed to incentivizing coordination in payment structures. All of these are correct answers. Please bring up in deliberations.
Uma Ahluwalia
01:58:45
Agree Kristin
Leah.Woodall
01:59:18
Strongly feel that this council not be Legislated.....it would be best served to remove barriers of bureaucracy,
Aileen Fink
02:01:13
Given the earlier data from survey on the differences in frequency of services used, I would think we would want to increase the professionals who provide the high demand services
Kristin Dwyer, Delaware
02:01:25
Thank you Leah, if Diana or Uma could elaborate if they know, how service delivery and the dialog around it changed when MD legislated a similar council would be helpful
Drew Hawkinson
02:01:50
To your question Dr. Mpasi, some students do not have access to a PCP (insurance, availability, trust etc.) the thought of that rec is to allow parents to bring siblings to siblings' SBWCs if they do not have a PCP.
Yvette Santiago
02:03:33
Kristin, at one point when we were looking to service the community, there was discussion that this would then be considered a community health center and stray away from the SBHC model.
Kristin Dwyer, Delaware
02:05:02
Yes, thank you Uma
Dr. Liz Brown (she/her)
02:05:13
Don’t schools have very different operating hours based on their grade level? Rather than standard 9-5, what about in relationship to the school day?
Leah.Woodall
02:06:07
I would echo Dr. Brown's comments....we need the sbhc hours of operation to be more flexible and driven by the local needs/resources
Yvette Santiago
02:06:20
Ditto on Dr. Brown's comments
Aileen Fink
02:06:28
might consider whether a larger space is needed that could accommodate groups for behavioral health services
Uma Ahluwalia
02:07:12
There were many discussions on hours of operations and we can fill folks in during the deliberations
Kathy Cannatelli
02:07:14
Take Joint Commission requirements that medical systems must adhere to when considering space and requirments
Leah.Woodall
02:07:16
Great job!!!
Aileen Fink
02:07:20
We have some data around prevalence of exposure to adverse childhood experiences (ACE hotspots)- would we consider that as a criteria?
Rep. Kim Williams
02:07:46
Can I see recommendation 5 again?
Kathy Cannatelli
02:08:06
Thank, Forrest
Cassandra Davis
02:09:34
Good job.
Jon Cooper
02:10:56
Well done, Forrest!!
coneill
02:14:27
I believe these tools are used based on need of studets and training of behavioral health staff, as well as intragration of WC in school. I agree it would be good to have it standardized
Yvette Santiago
02:16:11
Will need to engage DE School Boards Association on recommendation #2; perhaps the recommendation from the standing group to the School Board may be a good compromise or intermediary
Dr. Liz Brown (she/her)
02:18:41
Need to step away, will be back this afternoon
Aileen Fink
02:21:14
CLAS= culturally and linguistically appropriate services
Yvette Santiago
02:22:51
huge gap and need for pediatric dentists in this state;
Marihelen Barrett
02:22:58
Encourage you to bring Nicholas Conte, Dental Director for DPH into the discussion about dental for exploring design and implementation - if you haven’t already talked with him.
Frances A Russo-Avena
02:23:08
Does DPH still offer dental services in our schools?
Drew Hawkinson
02:23:22
Thank you Midge, Dr. Conte served on the infrastructure, policy, and operations workgroup.
Forrest Watson III
02:23:29
Certainly support dental and vision inclusion in the prevention model at SBWCs. Very important!
Forrest Watson III
02:26:57
The recommended space for SBWCs was proposed to accommodate mobile dental and vision screenings at SBWCs.
Aileen Fink
02:34:15
If we use diagnoses as a measure, we'll need a mechanism to update the data collection since diagnoses can change over time.
Yvette Santiago
02:35:20
ditto eileen
Aileen Fink
02:36:26
Great job Kristen and Kathy!
Leah.Woodall
02:36:40
Great job Kristen and Kathy!
Jon Cooper
02:37:11
Fantastic context for the recommendations!
Cassandra Davis
02:37:28
Thanks Kathy and Kristen. Good job.
Forrest Watson III
02:37:45
Good job Kathy and Kristen! Well done.
Rep. Kim Williams
02:38:23
Great work Forrest, Kathy and Kristin.
Uma Ahluwalia
02:39:33
Did they ever come? that is progress:)
Forrest Watson III
02:41:14
Are we talking about collecting from insurers or clients?
Kristin Dwyer, Delaware
02:41:56
Yvette- are these recommendations one that will have to be legislated?
Forrest Watson III
02:42:14
thanks
Kristin Dwyer, Delaware
02:42:40
thank just trying to understand what the solutions are
Aileen Fink
02:46:05
Which underscores the importance of the data to demonstrate those outcomes!
Marihelen Barrett
02:47:15
I would add to the “sell” to insurers the value of helping them improve their results on HEDIS and EPSDT measures (for Medicaid MCOs)
Forrest Watson III
02:47:57
To get SBWCs services to be classified as preventative, it may take a two fold effort, 1. focus at the state level, and 2. at the national level for advocacy around inclusion in the Affordable Care Act definition of prevention services.
Kristin Dwyer, Delaware
02:49:11
Yvette- I have a question
Frances A Russo-Avena
02:50:04
Forrest, Hopefully there is consideration in doing a longitudinal study of a cohort of students to help gain prevention data as well as acadmeic success data
Marihelen Barrett
02:52:06
I am a little concern about the focus on expansion to high needs schools - I understand that is a reasonable place to start and to target resources as we build more resources. But I would like to see our philosophy still be that all children needs this (just as they need education and school nurses) - especially in the future - to deal with the massive problems of chronic illness, obesity, and mental health/trauma - We know that these needs are not limited to uninsured students or high need communities.
Sen Dave Sokola DE
02:52:38
Maybe a separate specific capital outlay per district that allows the local share to be handled the way minor capital local share is handled.
Forrest Watson III
02:53:08
I agree Midge!
Marihelen Barrett
02:53:16
Thank you, Senator Sokola - that is a great idea
Aileen Fink
02:53:52
I wasn't part of the group but as someone who has gone through these processes, it is very time consuming and cumbersome.
Rep. Kim Williams
02:53:54
Are there any federal funds/grants available to support wellness centers?
Marihelen Barrett
02:55:39
I am worried about the focus on fitting SBHC into the existing third party payment system - which is too administratively burdensome. I would like to see us move to a new payor system that is not based on fee for service.
Aileen Fink
03:02:08
It will important to coordinate with the Division of Substance Use and Mental Health and DSCYF who currently receive federal funding for substance use/misuse prevention.
coneill
03:02:08
can you state that in the chat?
Frances A Russo-Avena
03:02:46
Can you also include DSCYF. I believe DSAMH has also provided grant funds to school districts for Wellness. A nice way to collaborate
Kristin Dwyer, Delaware
03:03:58
Thank you definitely worth looking into
Kristin Dwyer, Delaware
03:04:15
required vs voluntary and how to incentivize
Kristin Dwyer, Delaware
03:07:04
Great work!! thank you Jon and Yvette
Rep. Kim Williams
03:07:45
Great work Yvette and Jon.
Jon Cooper
03:08:14
Thx; Aileen! We had tons of help!!!!
Forrest Watson III
03:08:26
Again great work Yvette and Jon! Difficult subject clear presentation!
Cassandra Davis
03:09:04
Good job! Thank you for your thorough overviews of the recommendations.
Marihelen Barrett
03:09:42
Thank you everyone. This is great work that will really move Wellness Centers forward as part of Delaware’s overall commitment to children. I am impressed, thankful and grateful. Best wishes to all of you for a Merry Christmas and Holiday Season. I have to jump off now. Looking forward to the next phase.
Jon Cooper
03:09:55
BRB - I need to take a quick call.
Yvette Santiago
03:10:24
thanks, midge..you too
Priscilla Mpasi
03:15:02
Can I make a comment please
Leah.Woodall
03:15:08
AMAZING work by all!!!! Thank you!!
Aileen Fink
03:15:12
Great job Yvette and Jon!
Susan Haberstroh DDOE
03:15:35
Amazing work and thought going into all of this. Thank you.
Jon Cooper
03:18:38
Thank you, Dr. Mpasi
Leah.Woodall
03:19:46
Thank you Dr. Mpasi
Kristin Dwyer, Delaware
03:21:21
Also, I think we look at it based on current usage- SBHC are primarily in HS
Kristin Dwyer, Delaware
03:23:00
sports physicals are again an enrollment issue in HS
Kristin Dwyer, Delaware
03:23:45
Changes will happen in elementary and middle school- usage change with need and need is different at different ages and stages
coneill
03:24:17
SBWC work to link students with PCP and collaborate
Rep. Kim Williams
03:24:22
We want to increase enrollment and provide services. We want to do what is best for our students. There is a shortage of primary doctors especially in our poorer communities.
Drew Hawkinson
03:25:51
Thank you all for the conversation this morning. We will reconvene at 12:30 PM EST. As we go into our deliberation, this is a reminder that by prioritizing the recommendations, we are prioritizing the recommendations themselves and not the details of their implementation. We will have 30 minutes to discuss each set of recommendations. By marking "Discuss" for a recommendation, this means that you would like to discuss a question or concern on the relevant idea of a recommendation, not the details of its implementation.
Frances A Russo-Avena
03:28:44
Dr. Mpasi, To your point, and as a former school nurse, I'd be happy to share my experience with community providers meeting student needs, as well as our vision and goals for the initiation of an elementary SBWC in an underserved community. It truly was meant to be in partenrship with primary providers as I believe it does presently function in that capacity
Priscilla Mpasi
03:30:55
Yes Rep. Willams I certainly understand the intent to increase enrollment and provide services. When it comes to services there has to be consideration of which services. Resources such as providers, health staff, time and finances must be considered and they are finite. If resources were infinitely available then primary practices could fully service all children. But there are not enough resources so they cannot. And SBHCs should then provide the services that are of greatest need and utmost priority first to help fill the gap and complement health services. Though if SBHCs are providing multiple services then they too will experience resource limitation issues
Priscilla Mpasi
03:32:31
I think my comments were heard that I do not want SBHCs to provide services rather I want to ensure that they can function at highest capacity based on staff, funding and addressing patient need. And the services provided align with what the practices are struggling to provide
Priscilla Mpasi
03:32:56
I'm looking forward to the dialogue in the breakout rooms to further explore this
Christina Bryan
05:40:32
Sorry everyone that I was unable to join the earlier sessions, but urgent COVID projects have taken over my day! I hope to be on for the remaining time. Thank you. -Christina Bryan
Yvette Santiago
05:41:53
Great job, Uma! And no worries, Christine! Glad you're on
Jon Cooper
05:42:41
Great to have you, Christina!!
Kristin Dwyer, Delaware
05:50:22
Thank you!
Forrest Watson III
05:51:10
Good job Catlin and Ana!
Kristin Dwyer, Delaware
05:57:04
I am good
Kristin Dwyer, Delaware
05:58:04
Quick question
Kristin Dwyer, Delaware
05:58:16
Can it be created/authorized via legislation?
Kristin Dwyer, Delaware
05:58:35
rather then it be run by the legislature
Leah.Woodall
06:04:20
reminder there are currently 7 elementary sbhcs
Kristin Dwyer, Delaware
06:07:53
very helpful, thank you Gloria
Frances A Russo-Avena
06:08:27
good point
Dr. Liz Brown (she/her)
06:09:39
Culturally and linguistically appropriate services
Aileen Fink
06:10:07
Culturally and Linguistically Appropriate Services
Leah.Woodall
06:10:34
Current language in code/regulations - provides through licensed professionals primary health services to children, including comprehensive health assessments, diagnosis, and treatment of minor, acute, and chronic medical conditions, referrals to and follow up for specialty care and oral and vision health services, mental health and substance use disorder assessments, crisis intervention, counseling, treatment, and referral to a continuum of mental health and substance abuse services including emergency psychiatric care, community support programs, inpatient care, and outpatient programs,
Christina Bryan
06:15:55
I would think long term would be needed for EHRs in particular
Priscilla Mpasi
06:26:56
Great recs
Priscilla Mpasi
06:27:49
Would want to even consider more robust staff to meet behavioral health needs
Drew Hawkinson
06:35:48
We will come back from break at 3:30 PM EST for our final activity on the agenda.
Frances A Russo-Avena
06:59:47
Tp
Frances A Russo-Avena
07:03:54
To add to Forrest's thoughts, there may need to be meaningful and thorough education provided to the various public agencies of what a SBWC is and how it impacts school communities. Would we want to include providers as well as community members in implementing the plan?