• Article
  • August 21, 2018

School-based Health Centers Provide Education and Services in 'Health Care Deserts'

Wolfson Children's Hospital's "big idea" brings health care and education into the community.

Hugh Greene, FACHE, president and chief executive officer of Baptist Health system in Jacksonville, Florida, wanted to create a program with a long-term sustainable impact on the community. As his team dug in on his vision, they focused on the city's northern and western neighborhoods. The statistics in these areas leapt off the page:

  • 15,000 pediatric emergency department (ED) visits
  • 94 percent of kids didn't have a regular pediatrician

"We realized we were looking at 'health care deserts' when it came to pediatrics," says Michael Aubin, FACHE, president of Wolfson Children's Hospital in Jacksonville, one of five hospitals in the Baptist Health system. "There were no physicians taking care of pediatric patients in those areas. Essentially, the ED became their primary care office, which obviously is not the right answer." Their mission was clear—these children needed a medical home. 

Medical services, health education and social services

"We didn't want to become a typical primary care doctor's office," Aubin says. "This community needed more fundamental change." The approach, which was known within Baptist Health and Wolfson Children's as "The Big Idea," established a three-pronged effort of medical services, health education and social services for these communities. It was less clear exactly how to provide an effective, sustainable medical home for this population.

The team researched a variety of potential models, tapping expertise from institutions around the country. All roads seemed to point toward a school-based health center model, with the Ribault Middle and High Schools in north Jacksonville as prime locations for the first centers. In these schools, Aubin and his team found built-in advantages in two important categories:

  • Economic. The schools already had clinics onsite, so there wasn't the added expense or time needed to build a new facility. And Ribault High School already had a facility where Wolfson Children's could build the Family Resource Center, a traditional primary care office that serves all children under 21 in the community. 
  • Geographic. Not only were the schools located within the target communities, they were also familiar and visible locations to residents. Further, the schools at all levels, from elementary through high school, shared adjacent campus locations—making it easier to staff the health center facilities.

Even with these existing advantages, funding the program posed a challenge. Wolfson Children's had the resources to get the ball rolling, but building—and ultimately expanding—a sustainable program would require assistance. The answer: aligning with a federally qualified health center (FQHC). 

Partnering with two FQHCs in the area (AGAPE Community Health Center and Sulzbacher Medical Center) allowed for the services provided in the school-based health centers to be reimbursed at a higher rate than typical Medicaid reimbursement rates. "I can't emphasize enough how important the relationship is with the FQHCs, because they're essentially the financial arm," Aubin says.

"We knew to make a long-term sustainable model economically viable, we needed to have some other approach that would help pay the bills. The exciting part was this would allow us to expand quickly, as opposed to taking a lot of time—essentially years—working on one center, just to be able to get to the next center." 

Information to build on

Now several months in, Aubin says the hospital has learned lessons that will help shape subsequent school-based health centers and can help inform similar projects elsewhere:

  • Timing. Consider the school calendar when opening a center. Opening in January, the Ribault centers missed the push for permission slips, physician assignments and health insurance registrations that typically takes place at the beginning of the school year. 
  • Community involvement. It's important to get buy-in from all stakeholders; Aubin says including the school superintendent, principals, parent-teacher organizations and alumni groups in the planning of the health centers was essential.
  • Grassroots education. The concept of preventive medicine is foreign to this population, according to Aubin. Educating the community on a door-to-door basis on the importance of the continuity of care is vital to shifting the culture of dependency on EDs for primary medical care.

Wolfson Children's is establishing data points to measure the impact of the Ribault health centers. Aubin says bringing down ED utilization and increasing the number of kids with a pediatrician are the primary benchmarks. Meanwhile, plans are underway to open the next school-based health centers in Jacksonville next summer.

Send questions or comments to magazine@childrenshospitals.org.