Yesterday Kelly Firesheets and I visited one of our newest School-Based Health Centers located in Manchester School in Adams County. While only in operation a few weeks, it was impressive that they have already enrolled 620 students and school personnel! The staff was busy seeing a steady stream of children. It was wonderful to see the exceptional results of this grant. Superintendent Robert Ralstin attributes this success to their collaborative upfront planning and the things the school has put in place to facilitate the students' enrollment. They anticipate enrolling many additional students. Adams County Regional Medical Center is currently seeking a full time nurse practitioner to add to this center. This site recieved a HRSA grant that will enable them to build a larger center and provide primary care, dental and mental health services.

Last week I was in Erie, Pennsylvania, presenting at a community forum. One of the speakers reminisced about his youth and how his family doctor practiced in a house in the neighborhood. That doctor was an integral part of the community and the speaker's childhood. In most places, that type of access to a family physician no longer exists. However, 2,000 communities across the nation have access to another provider that also plays an integral part in a community and in the lives of children and families: the school-based health center (SBHC). SBHCs are as local- and community-driven as healthcare can get these days. The school community--school staff, parents, students, supporters, and neighborhood representatives--helps define the SBHC and the services it will provide. One of the identified concerns about healthcare reform is the limited access to primary care services. At this point, it is estimated that once everyone has health insurance and begins seeking regular, on-going primary care services, these services will be hard to get because there won't be enough providers. This is where the SBHCs can play a role. SBHCs are mostly located in communities that have high numbers of uninsured adults, in addition to high numbers of children with Medicaid or no insurance. Structuring the SBHCs to be open to the community--and not just school children--will allow more access points in communities where they will be needed the most. One of the hidden gems in the healthcare reform bill is support for expanding SBHCs. The bill makes $200 million beginning this year available to provide capital improvements, equipment, and other supports for SBHCs. Those funds could be used to remodel existing facilities to make them available to the community while keeping the kids safe and sound in the school building. Doesn't that seem like a great way to bring the local doc back into the community and create an important relationship and childhood memory for today's children?

I am often asked the question, "What do you want to see in this site visit?" My answer is, "It's not 'what,' it's 'who'." The reality is that a site visit is really a people visit, because people make the project.

A good site visit, whether it is related to getting a grant or reporting on an existing grant, has some specific components:

• More than one person represents the project, whether it is collaborative or internal to an organization.
  
• All (or most) collaborators are represented and prepared to speak about the project.
  
• All collaborators have a copy of the proposal or report and have had time to read it.
  
• A program participant is present and willing to talk about what this will mean or what it has meant to them, if possible.
  
• It is located in one of the sites used in the project.

• a description of the proposed project or work done in the reporting period by the people involved,
  
• questions from those making the site visit (Health Foundation staff or board members),
  
• suggestions for improving the proposal or the existing project, and
  
• timelines for any follow-up from the Health Foundation or the grantee.

Site visits are not meant to be scary...they give grantees the chance to show us who you are and vice versa. It is important that we all feel free to share our thoughts, our dreams, our challenges in doing this work with each other. So look forward to your next site visit!!!

In my next blog – what is the difference between a proposal site visit and an annual or final site visit?

I was recently at a conference where a health care futurist was describing health care reform possibilities under President Obama and the future of health care with the baby boomers retiring. During his presentation he made a comment that if Medicare is not reformed, he will be walking around with a big "M" on his forehead and no doctor will want to treat him (due to low payments). My reaction.... "Welcome to the world of a child on Medicaid." His statement indicates that he deserves the best medical care in his elder years. Of course he does. But so do our children. Medicaid pays approximately 1/3 of what private insurance pays for regular primary care. If you were a private doctor, would you treat Medicaid-insured children? The SCHIP Reauthorization Act allows states to expand Medicaid coverage up to 300% of the federal poverty guidelines (approximately $62,000 for a family of four). The expanded eligibility will cover millions more children. While this is good news, there is a sense in Washington that health care reform for children is solved. Current health care reform discussions are revolving around Medicare and uninsured adult care; also good news. However, I must argue that the SCHIP expansion does not solve all the barriers for children. If there aren't doctors willing to treat children with Medicaid- what good is having coverage?

Last month, over 600,000 people filed for unemployment assistance and more and more workers face pay cuts or forced time off. What does that mean for our children? More of them will loose access to private insurance, either due to a lost job, reduced income, or benefit cuts. That is a lot of burden on a family and could be a bigger burden on the taxpayer. On February 4th, President Obama signed the SCHIP Reauthorization Act into law. This extremely important piece of legislation couldn't come at a more opportune time. The SCHIP Reauthorization Act will provide coverage for kids that live under 300% of the federal poverty level ($66,150 for a family of 4). In a time when a family is facing difficult financial issues, knowing that your child can go to the doctor will now be one less worry. And for the tax payer, giving parents the capability of providing early intervention services will reduce wasteful emergency room visits and high-cost health care services. One way of providing quality, easily accessible, and cost efficient health care to kids is the school-based health center. Those of you familiar with the Health Foundation know that we support this model of care delivery. Thanks to the hard work of the National Assembly on School-Based Health Care and Representative Stabenow's office, the SCHIP Reauthorization Act included a definition of school-based health centers. This is the first time SBHCs have been defined in any federal insurance reimbursement program and provides the path for future opportunities in the Public Health Service Act. I would like to thank everyone (advocates and elected officials) who supported and worked on getting this legislation written and passed. Our children need our support and access to health care services.

As with each new year, there are always new opportunities, and 2009 is definitely a year full of promises for new opportunities. This is certainly true for the field of school-based health care.

Several opportunities will be available shortly after President-elect Obama and his new administration take office. One of the new Congress' first priorities will be SCHIP reauthorization. Congress is expected to pass the expanded version that was previously vetoed. The original legislation contains support for school-based health centers. In addition to SCHIP Reauthorization, President-elect Obama has identified health care reform as one of his top priorities. Several congressional members are currently writing health care reform legislation and at least two identify school-based health centers are part of the reformed system. In addition to the health-related opportunities, President-elect Obama has nominated the Chicago Public Schools Superintendent, Arne Duncan, as the new Secretary of Education. Mr. Duncan is a known advocate for improving academic outcomes through educational reform and by providing students additional support services, such as school-based health centers. His vocal support of such services will definitely assist the advocacy efforts of the school-based health care field.

It appears that the field of school-based health care is gaining support all the way to the top! As with all opportunities, you have to be ready to respond and seize it. If you are a supported of school-based health services, I recommend you keep a close watch on the national scene!