SBHC Standards.pdf

T H E M A I N E S C H O O L - B A S E D

H E A LT H C E N T E R S S T A N D A R D S

APRIL 2003

1M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

AC K N O W L E D G E M E N T S

The Teen and Young Adult Health Program would like to acknowledge the following individuals for contributions to the development of Maine’s School-Based Health Center Standards:

Judy Angsten

Lisa Belanger

Barbara Crowley

Judy Feinstein

Cindy Flye

DeEtte Hall

Bonnie Hopper

Barbara Leonard

3M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

TA B L E O F C O N T E N T S

Introduction

Section A. Structure and Access to Services (Standards A1–A8)

Section B. Health Services (Standards B9–B14)

Section C. Professional Competency (Standards C15–C21)

Section D. Quality Management and Improvement (Standards D22–D26)

Section E. Communication and School Health Coordination (Standards E27–E33)

Section F. Clients’ Rights and Responsibilities (Standards F34–F36)

Section G. Medical Records (Standards G37–G39)

Appendix I

Appendix II

Appendix III

Appendix IV

Appendix V

Contact Information

5M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

I N T R O D U C T I O N

The School-Based Health Centers (SBHCs) in Maine provide primary health care and mental health services to students from pre-kindergarten through twelfth grade. These centers are located on school grounds, where students have easy access, and are staffed by licensed medical providers. They may be operated by the school or by community health agencies.

Some SBHCs may include primary care providers from the community as staff, and some SBHCs may also play the role of “primary care provider of last resort.” All SBHCs play a critical role as a partner with community providers to optimize health outcomes for students by monitoring their health and enhancing their access to needed care.

The SBHC standards have been developed by the Bureau of Health, the State agency that administers grants to the SBHCs, and representatives and advocates for the SBHCs throughout the State. They are intended to provide guidance for the SBHCs and entities working with the SBHCs and outline expectations for quality operations and provision of services. The intent of these standards is not to supersede Maine Law, but to give the SBHCs additional guidance. Requirements that are specified by law and regulation are emphasized by the use of the word “must.” Standards that are not specified by law but are considered important for program success use the word “should.”

National Committee for Quality Assurance (NCQA) 1997 standards provided the initial outline for these standards. The Principles and Goals for the SBHCs developed by National Assembly on School-Based Health Care (NASBHC) and standards developed by other states and summarized by the National Assembly on School-Based Health Care (NASBHC) were used as additional references. Cross-references with the current NCQA standards, and NASBHC principles and other states’ standards are included in Appendices 1, 2, and 3.

Definitions: For the purpose of these standards, a School-Based Health Center is defined as a site located on school premises, providing at a minimum eight hours of primary care services per week and having these services at least two days per week. Some SBHCs also provide behavioral health services (mental health and substance abuse services) and/or primary oral health services. In addition to School-Based Health Centers, some agencies and schools collaborate to provide school-linked physical and behavioral health services and others provide only school-based behavioral health services. School-linked programs provide similar services to school-based programs, but are located off school grounds at community agencies that have cooperative agreements or memoranda of understanding with the school and/or services specifically designed to meet student needs. At some schools, limited expanded school health services are provided, but if these services are less than the minimums listed above, these services are not defined as a School-Based Health Center. Although many of these standards may be applicable to school-linked health services, school-based behavioral health services, and limited expanded health services, they may not all be applicable and are not intended to encompass all of the issues that these arrangements may need to address. Such programs are encouraged to review these standards and adopt as many of them as they deem appropriate.

Please note that these standards refer at different times to clients meaning all those, including any non-students, who are receiving the SBHC services beyond school nursing services, and to students, meaning all students enrolled in the school regardless of participation in the SBHC.

7M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

ST R U C T U R E A N D A C C E S S

T O S E R V I C E S

The SBHCs may vary considerably in their organizational structure and scope of services offered. However, all the SBHCs should have structural and programmatic supports in place that allow them to serve the needs of students in the school and provide quality services.

STANDARD A1. GOVERNING STRUCTURE

The SBHC governing structure should include:

• A clinical director (defined as an individual who carries a current license to provide primary care independently in the State of Maine) who provides guidance in program development, delivery of services, and other program activities.

• An advisory committee or board that provides guidance in program and policy development. The committee or board should consist of representatives from the school, the community (including local physicians), families, and students. The advisory committee or board should meet at least annually and meetings should be documented.

• Documentation describing the organizational governing structure and all established policies and procedures.

STANDARD A2. FACILITIES

The SBHC should have facilities that are appropriate for the services it provides. These must include:

• A location that is accessible to all students and clients.

• A secure place to store medical records (See Section Standard G37, Record Keeping System).

• A secure place to store lab supplies and pharmaceuticals. Supplies and drugs should be inventoried regularly, and outdated items disposed of appropriately.

• Current fire and building safety certificates and appropriate liability coverage.

The facilities should also have:

• A waiting and reception area that allows for appropriate confidentiality.

• Appropriate space for confidential counseling if behavioral health services are offered on-site.

• Policies and procedures that comply with laws and regulations governing health facilities, including those specifically regarding infection control and laboratory operations.

• At least one exam room that provides for privacy and has a hand-washing sink.

• Confidential telephone and fax access. (See Section Standard E27, Client Communication.)

• Clearly marked exits.

• Appropriate safety, emergency, and first aid supplies.

• All areas are clean and free of hazards.

S E C T I O N A

8 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

STANDARD A3. MISSION

The SBHC should establish a clear mission. This mission should help define the SBHC’s scope of services and include public health goals of:

• Assessment of the health status and health needs and strengths of the school population.

• Development of sound school health policies through collaboration with and assistance to the school nurses and other school health and administrative personnel.

• Assurance of access to high quality, age-appropriate health services, including behavioral health services, for all students.

• Early prevention and health promotion for the school-aged population.

(See also Section B, Health Services.)

STANDARD A4. NEEDS ASSESSMENT

The SBHCs should base their services on a local assessment of needs and resources. The needs assessment should:

• Be a clearly defined process.

• Include the participation of students, families, school staff, community providers, and other stakeholders.

• Be regularly updated.

STANDARD A5. NONDISCRIMINATION

In accordance with the Maine Human Rights Act (Title 5, Section 4552), the SBHCs must not discriminate against students based on race, color, sex, physical, or mental disability, religion, ancestry, or national origin. This policy should be clearly communicated to students, families, school staff, and community members. They should demonstrate sensitivity to issues of special populations such as lesbians, gays, and bisexuals, learning disabled students, physically or emotionally disabled students, and racial and ethnic minorities.

STANDARD A6. ACCESSIBILITY OF PRACTITIONERS AND SERVICES

The SBHC should document that it has policies and procedures to assist in assuring students’ and clients’ access to primary care, behavioral health, and oral health services. The SBHC should have a plan to identify and eliminate or reduce barriers to access that includes:

• Adequate and consistent hours of services at times convenient for students. “Adequate” hours should be defined by the needs of the population, but should include enough open days and hours per week that students are familiar with the SBHC staff and can make appointments that do not interfere with classroom learning. This standard is met for Maine SBHCs if the SBHC provides a combination of physical health services by a nurse practitioner, physician assistant, or physician for at least:

➤ eight hours per week, and

➤ two days per week, for a minimum of one hour each of those days.

• Assistance for clients in establishing a medical home, defined as an identified primary care provider who provides for:

➤ accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective medical care, including regular preventive care.

9M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

➤ a partnership of mutual responsibility and trust between the provider and the client and family.

➤ access to 24-hour, 7-day-a-week, on-call coverage for provision of acute care as needed.

➤ management of chronic conditions.

➤ referrals for subspecialty care and ancillary services as appropriate.

➤ coordination of care with all clients’ providers as appropriate.

• Policies and procedures that:

➤ define the clients who will be served in the SBHC.

➤ assure that the ability to pay will not be a barrier to enrollment.

➤ specify arrangements for timely access to care 24 hours a day and seven days a week, through the medical home as described above or through alternate arrangements when a medical home has not yet been established.

➤ provide for continuity of care during summers and school vacations, through the medical home as described above or through alternate arrangements when a medical home has not yet been established, including access to records during these periods.

STANDARD A7. F ISCAL ACCOUNTABILITY

The SBHC should have an accounting system in place that budgets and tracks income and expenses and allows for regular reviews by the advisory committee and sponsoring organizations.

STANDARD A8. BILLING AND CONTRACTING WITH HEALTH

PLANS AND MAINECARE

The SBHC should develop the capacity to bill for services as appropriate. They should be familiar with requirements of MaineCare and the major health plans (private health care insurers) of their client population. Where possible the SBHC should seek membership in appropriate health plan networks. The SBHC and its practitioners should:

• Assess the insurance status of all clients.

• Provide information and assistance to uninsured clients in the MaineCare enrollment process.

• Provide for appropriate health plan and MaineCare access to their members’ medical records at the SBHC to the extent that the law permits.

• Seek reimbursement when the requirements of reimbursement would not compromise the quality of care, including maintaining confidentiality and communicating with patients regarding treatment alternatives.

• Cooperate with health plans’ credentialing requirements, including the health plans’ supervision requirements and quality assurance program and activities, as appropriate, recognizing that credentialing and re-credentialing are keys to health plan quality standards and appropriate reimbursement. (See also Section D, Quality Management and Improvement.)

11M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

HE A L T H S E R V I C E S

S E C T I O N B

Although the specific mix of services should be determined by the needs of the SBHC’s population; at a minimum, the SBHC should provide primary direct care that includes assessment, diagnosis, and treatment provided by a nurse practitioner, a physician assistant, or a physician. The SBHC should have policies and procedures for promoting preventive health services, managing chronic health conditions, providing care for acute medical conditions, enabling access to behavioral health services, addressing preventive and immediate oral health needs, and making appropriate referrals with follow-up for services not provided directly. Services at the SBHCs should be designed to provide health promotion and education and early intervention of disease and illness. (Also see Standard D24, Clinical Practice Guidelines.)

STANDARD B9. SCOPE OF SERVICES

The SBHC should have written policies that outline the scope of services provided, including which services will be provided directly and which will be referred to other community providers. All primary health, oral health, and behavioral health needs of enrolled clients should be addressed in the scope of services either by direct provision of the services or through referral to community health providers.

STANDARD B10. PREVENTIVE CARE

The SBHC should provide preventive care for all students who visit the center for a preventive physical exam and all students who visit the center at least three times in the course of a school year. The preventive care should follow appropriate Bright Futures Guidelines and include an assessment of risk and protective factors. The Bright Futures Guidelines can be accessed at: http://www.brightfutures.org/bf2/about.html.

STANDARD B11. ACUTE CARE

The SBHC should provide assessment and treatment of acute medical conditions in a timely manner, including providing appropriate intervention and referrals. The SBHC should have written policies that define its role in urgent medical care in the school. (See also Section E, Communication and School Health Coordination.)

STANDARD B12. BEHAVIORAL AND MENTAL HEALTH SERVICES

Behavioral health services are defined in these standards as services that address substance use, mental health, and related conditions. The SBHC should provide initial assessment and treatment or referrals for behavioral health needs of enrolled students. The SBHC should have written policies that define its role in behavioral health crises in the school.

(See also Section E, Communication and School Health Coordination.)

12 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

STANDARD B13. CHRONIC HEALTH CONDITIONS

The SBHC should have policies and procedures designed to improve the health status of clients with chronic health conditions, including chronic mental health conditions. The center should identify clients with known chronic conditions and assist them with management plans as appropriate. The center should follow up with clients with newly diagnosed chronic conditions to ensure coordination with primary care and other providers.

(See also Standard A6, Accessibility of Practitioners and Services, and Standard E27, Client Communication.)

STANDARD B14. ORAL HEALTH CARE

The SBHC should provide referrals or treatment for oral health services, including preventive care, urgent restorative care, and the establishment of an “oral health home.”

13M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

Licensing and training are essential to ensure that the SBHC services are provided by appropriate professionally competent practitioners. The SBHC should have policies and procedures in place to reflect the following standards:

STANDARD C15. L ICENSING AND BACKGROUND CHECKS

Professional providers should be licensed and practice according to State licensing standards.

The SBHC should have a process in place for ensuring new employees have proper licenses and credentials and for annually reviewing licensing, credentialing, and sanctions. School nurses employed by the SBHC should have school nursing certification through the Maine Department of Education. All the SBHC staff should have background checks according to Department of Education policies for school personnel.

STANDARD C16. CONTINUING EDUCATION AND TRAINING

All staff and practitioners at the SBHC should obtain appropriate continuing education to improve and maintain their knowledge and skills. All staff should receive appropriate training in the SBHC’s policies and procedures, medical record keeping, and billing procedures. The SBHC should network with other SBHCs in the State at regular meetings to improve and maintain their knowledge of issues particular to the SBHCs.

STANDARD C17. SUPERVISION

The SBHC should provide for supervision that satisfies the licensure requirements of providers.

A medical consultant should be available to consult with all the SBHC staff as needed during hours when services are being provided.

STANDARD C18. ANNUAL PERFORMANCE APPRAISALS

All the SBHC staff should have annual performance appraisals completed by their employer to evaluate their professional performance, judgement, and clinical competence. Performance appraisals will be based on the following data, as appropriate:

• Client satisfaction and complaints.

• Quality improvement activity information, including participation in quality improvement plan and outcome assessments.

• Clinical care via client record reviews.

PR O F E S S I O N A L C O M P E T E N C Y

S E C T I O N C

14 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

STANDARD C19. DISCIPLINARY PROCEDURES

The SBHC has policies and procedures that enable the employer to appropriately discipline practitioners for issues of deficient quality of care and inadequate or inappropriate service delivery. These policies and procedures should outline the organization’s actions for:

• Developing a work plan to improve a practitioner’s performance.

• Listing circumstances that would constitute grounds for immediate suspension or termination.

• Establishing an appeals process within the disciplinary process.

• Informing practitioners of the disciplinary process.

• Communicating with the school if it is not the employer.

STANDARD C20. PERSONNEL F ILES

All employees should have job descriptions and resumes on file and should be appropriately trained for their assigned duties. Personnel files should include appropriate records of annual performance appraisals and disciplinary actions. Professional staff personnel files should include documentation of appropriate licenses, credentialing, and certification. Personnel policies should include a description of what, when, and how appropriate information will be shared with cooperating organizations such as the school.

STANDARD C21. F IRST AID AND CPR

The SBHC staff should be trained in general first aid and CPR.

15M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

The objective of a quality improvement (QI) program for the SBHC is to monitor and improve clinical care. A quality improvement program should include short- and long-term goals, describe the activities for reaching those goals, establish a time frame for accomplishing goals, and develop a mechanism for evaluation progress.

STANDARD D22. QUALITY IMPROVEMENT PROGRAM

STRUCTURE

The SBHC should define a quality improvement program, allocate adequate personnel and other resources, and assign responsibilities to appropriate individuals. The QI program should include the following elements:

• Designation of an individual responsible for quality improvement, such as the clinical director or a medical consultant. The designated individual should carry a current license to provide primary care independently in the State of Maine and have significant involvement in the implementation of the QI program.

• An annual QI work plan or schedule of activities (e.g., monitoring for identified issues, regular medical record reviews, and QI program evaluations) in which all staff have an active role. (Please see Standards C16, Continuing Education and Training, and C18, Annual Performance Appraisals, for further information on practitioners’ roles in QI and training.)

• A regular review of the QI plan, activities, and results by the SBHC advisory committee or board with related recommendations.

• Appropriate involvement with State, school, and health plans’ QI activities. (See Standard A8, Billing and Contracting with Health Plans and MaineCare, for involvement in health plans’ QI activities.)

STANDARD D23. SATISFACTION

The SBHC should have a system for assessing and assuring client satisfaction. Client satisfaction elements include, at a minimum, timely and low-barrier access to care, courteous, respectful, and helpful staff; good provider communication; allowance for enough time in appointments;

and appropriate confidentiality.

Components of this system should include at a minimum:

• An annual client satisfaction survey.

• Periodic satisfaction surveys of families, the school population (students and staff ), and community health care providers.

• Periodic review of member satisfaction results by practitioners and the advisory board.

(See also Standard F35, Grievances.)

Q U A L I T Y M A N A G E M E N T A N D I M P R O V E M E N T

S E C T I O N D

16 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

STANDARD D24. CLINICAL PRACTICE GUIDELINES

The SBHC should adopt and follow practice guidelines for providing care to clients with acute and chronic conditions. The SBHC should demonstrate the following:

• Clinical guidelines based on reasonable medical evidence and other established practice guidelines, such as those from the American Academy of Pediatrics.

• Policies and procedures that ensure safe and effective drug prescription and dispensing.

• Practitioners who are involved in adoption and periodic review of guidelines.

• Mechanisms that are developed to review guidelines every two years.

• Education of practitioners regarding guidelines.

• Client education and clinical care that are consistent with guidelines.

STANDARD D25. DATA COLLECTION AND ANALYSIS

The SBHC should collect and analyze clinical data to measure performance against State and professional standards. This data should be shared appropriately with practitioners and the advisory committee. It should be used to identify and implement interventions that will improve performance and to measure effectiveness of program activities.

STANDARD D26. CLINICAL QUALITY IMPROVEMENT ACTIVITIES,

INCLUDING INTERVENTION AND FOLLOW-UP

The quality improvement program’s composition should reflect the SBHC delivery system and important clinical issues of its clients, including the following:

• The SBHC should have a procedure for annually evaluating whether students are receiving preventive care, including oral health care.

• At least every two years, the SBHC should select at least one relevant clinical condition from primary care services or behavioral health services. This condition should be monitored and reviewed. Recommendations for service improvement should be developed based on this review.

• The SBHC should monitor utilization, continuity, and coordination of care for its clients.

17M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

As partners with community providers, the SBHC should establish communication policies and procedures that provide for quality patient care, organizational accountability, continuity of care, and patient confidentiality. As partners with the school, the SBHCs should have guidelines to define appropriate roles of school nursing and the SBHC services. These guidelines should be developed cooperatively with the SBHC organization and the school and satisfy Department of Education guidelines for school nursing as well as the SBHC guidelines. The guidelines should describe how the SBHC will be an integrated part of a coordinated school health program and will further Maine Learning Results.

STANDARD E27. CLIENT COMMUNICATION

The SBHC should have policies and procedures for appropriately communicating with clients, parents or guardians, primary care providers, and other health providers. These policies should provide for:

• Written informed consent to care (by students when allowed by law and competent to do so, and/or parents or guardians as appropriate), renewed on an established schedule.

• Continuity of care.

• Confidentiality.

STANDARD E28. DISSEMINATING OF INFORMATION ON

SERVICES AND POLICIES

The SBHC should have policies that describe the rights of all students and parents or guardians to regularly receive information on the SBHC, its services, and its policies on rights and responsibilities. This information should include:

• Services provided at the SBHC.

• The enrollment process.

• Policies on confidentiality and communication with parents or guardians and primary care providers.

• Policies on complaints and grievances.

The SBHC should also provide this information to school staff and community providers on request. This standard applies only to information about the SBHC, not to individual medical records within the SBHC. Please see Standard E27, Client Communication, and Section G, Medical Records, for standards on information sharing related to medical records.

C O M M U N I C A T I O N A N D S C H O O L H E A L T H C O O R D I N A T I O N

S E C T I O N E

STANDARD E29. ROLES AND RESPONSIBIL IT IES OF THE SBHCS

AND OTHER STUDENT SUPPORT STAFF

The SBHC should work cooperatively with student support staff and school personnel to establish clear and appropriate roles and responsibilities to ensure integration of school health programs and services. Such cooperative efforts should involve school nurses, counselors, social workers, behavioral health providers, teachers, and administrators when applicable.

The SBHC’s role in school crisis management should be defined. All roles and responsibilities should be defined in a written Memorandum of Agreement.

STANDARD E30. COORDINATION WITH SCHOOL NURSING

School nursing is essential to the operation of the SBHC, and the SBHCs cannot replace the services of a school nurse. There should be clear communication and coordination between the SBHC and the school nurse including:

• Clear definitions of roles and responsibilities of the SBHC and the school nurse.

• Participation of the school nurse on the SBHC advisory committee.

When school nursing is an integral part of the SBHC, school nursing functions of the SBHC should be provided by nurses certified by the Maine Department of Education.

STANDARD E31. ROLE IN COORDINATED SCHOOL HEALTH PROGRAMS

The SBHC should be part of a Coordinated School Health Program, and should follow the applicable guidelines for the School Counseling, Physical, and Behavioral Health Component of a Coordinated School Health Program. These guidelines are cross-referenced in Appendix IV and can also be found at www.mainecshp.com/school_counseling/guide-lines.html. The SBHC staff should participate in other components of the school health program, as appropriate.

STANDARD E32. ROLE IN MAINE LEARNING RESULTS

The SBHC should reinforce student learning results in health and physical education including:

• Health promotion and disease prevention concepts.

• How to acquire valid information on health issues, services, and products.

• Risk reduction and health promotion practices.

• Influences on health behaviors, including media, culture, technology, peers, and family.

• Communication skills that contribute to better health.

• Decision-making and goal setting leading to better health.

Further information on the Learning Results can be found at: www.state.me.us/education/lres/

STANDARD E33. NON-DISRUPTION OF CLASSROOM LEARNING

The SBHC should adopt policies that ensure that student learning is not disrupted:

• Scheduling appointments during non-classroom time when possible.

• Communicating with classroom teachers and other school staff about scheduled appointments as appropriate.

• Communicating with students and staff about such policies.

M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

The SBHC policies should promote respect for students, families, school staff, and community providers; acknowledge their rights and responsibilities; create mechanisms to ensure client confidentiality; and provide information on the SBHC services and policies. The policies on the SBHC clients’ rights and responsibilities should outline client entitlements and the SBHC expectations and must comply with Maine laws and regulations on informed consent and confidentiality.

STANDARD F34. RESPECT AND PRIVACY

The SBHC policies should clearly outline:

• The right of students and families to be treated with respect and dignity.

• The right of clients to privacy as allowable by law.

• The right of clients and parents or guardians of minor clients to take an active role with practitioners in making decisions regarding their health care, as allowable by law, including discussing treatment options for their health condition.

STANDARD F35. GRIEVANCES

The SBHC should have policies that include clients’ and parents’, or guardians’ rights to make complaints or grievances about the SBHC or services provided. These policies should describe the procedures for making such complaints and the SBHC’s process for addressing them.

STANDARD F36. CLIENT RESPONSIBIL IT IES

The SBHC should clearly communicate to clients and families:

• Their responsibilities to provide information that the SBHC and its practitioners need to appropriately care for clients.

• Clients’ responsibility, with the assistance of parents or guardians as appropriate, to follow their practitioner’s instructions for agreed-upon care.

L I E N T S ‘ R I G H T S A N D R E S P O N S I B I L I T I E S

S E C T I O N F

C

19M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

21M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

Medical records are a source of data that documents the extent and quality of health care a client receives from the SBHC. All standards should apply to electronic and paper medical record keeping systems. Release of any information contained in the medical records should be done only with the informed written consent of the student and/or parent and should abide by all State and Federal laws governing medical records release. (See Standard C16, Continuing Education and Training, for training on medical record keeping.)

STANDARD G37. RECORD KEEPING SYSTEM

The SBHC should have policies and procedures for an appropriate record keeping system that:

• Assures client confidentiality according to State and Federal laws and regulations.

• Facilitates communication (Please see Standard E27, Client Communication).

• Maintains current, complete, detailed, and organized documentation.

• Provides for secure short- and long-term storage of records.

• Keeps school nursing records that come under FERPA regulations separate from other SBHC medical records.

STANDARD G38. CRITICAL ELEMENTS

This standard establishes medical record criteria that the SBHC should promote to attain consistency among practitioners. Regular record reviews should be included in the SBHC’s Quality Improvement plan. (See Section D, Quality Management and Improvement.) The following elements are considered critical and should be present in all medical records:

• Record of illnesses and medical conditions on a problem list.

• Documentation of allergies and medications.

• Record of appropriate medical history.

• Documentation of diagnoses consistent with findings.

• Record of treatment plans that are appropriate for the recorded diagnoses and do not put the client at risk of diagnostic or therapeutic problems.

M E D I C A L R E C O R D S

S E C T I O N G

22 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

STANDARD G39. ADDITIONAL ELEMENTS

The following elements of medical records are important and should be included in all records.

However, since they are less critical than the elements listed in Standard G38, Critical Elements, this standard will be met if 60% of reviewed records have all of the following 14 elements and 90% of reviewed records have at least 11 elements:

• Documentation of patient’s name or ID number on every page.

• Documentation of patient’s biographical information (address, parents or guardians, home and work telephone numbers).

• Documentation of author identification for medical record entries. Author identification can be handwritten, stamped, or electronic.

• Legibility of medical records such that they can be read by someone other than the author.

• Documentation that history and physical exam records contain subjective and objective information appropriate to the patient’s presenting complaints.

• Documentation that the appropriate laboratory tests are ordered.

• Documentation on encounter forms indicating follow-up care, calls, or visits.

• Documentation that problems for previous visits are addressed at follow-up visits.

• Documentation of client requests for specialty care.

• Documentation of referrals and referral status.

• Consultations, abnormal lab results should have notation in record for follow-up plans.

• Documentation that immunization records are up-to-date.

• Documentation regarding the use of cigarettes, alcohol, and other substances and the presence or absence of other risk behaviors.

• Indication in the medical record that preventive screening and services are provided in compliance with the SBHC and Managed Care Organization (MCO) practice guidelines.

23M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

WHAT THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE

(NCQA) LOOKS FOR IN A HEALTH PLAN

Cross-referenced with Maine SBHC Standards

Since Maine started the development of State Standards for the SBHCs, NCQA has made changes in how they evaluate the quality of Health Plans. The following elements are taken from their Web site, and are grouped under five categories: Access and Service (with elements for each), Qualified Providers, Staying Healthy, Getting Better, and Living with Illness.

Because the payment of quality health care has different requirements than the provision of health care, and because health plans serve all ages, not only school-aged children, not all of these elements are applicable to the SBHC standards. Other elements are reflected differently in the Maine SBHC standards than by NCQA.

AP P E N D I X I

Maine Standard reference NCQA Evaluation Element

A4 A well-defined process that the health plan uses to make decisions about covering medical treatments and services for plan members.

A5, A6, B9, D24 Fair and consistent health plan decisions about medical treatments and services provided to plan members.

B9, C15 Evidence that qualified health plan professionals make decisions about medical treatments and services provided to plan members.

D24 (not explicit)

A process for evaluating new medical procedures, drugs, and devices.

A6, E29 Evidence that plan members get needed emergency services.

A6, B9 Procedures that ensure health plan members get the level of care they need.

A4, A6 Evidence of improving the availability of doctors and other practitioners.

ACCESS

Maine Standard reference NCQA Evaluation Element not applicable Prompt decisions about coverage of medical treatments and services for plan members.

D24 Evidence that health plan’s decisions about medical treatment and service are based on acceptable standards for medical practice.

not applicable Clear communications from the health plan to members and doctors about reasons for denying medical treatments or services and about the process for appealing plan decisions to deny treatment or services.

F35 Processes to resolve member complaints and appeals of health plan decisions.

F35 Evidence of fair and prompt handling of complaints and appeals from plan members.

D23 Members’ and doctors’ satisfaction with how the health plan makes decisions about coverage of medical treatments and services for plan members.

24 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

Maine Standard reference NCQA Evaluation Element

A4, A6, B10, B11, B12

Evidence of improving access to primary care and behavioral health care and to customer support.

F Policies that define the rights and responsibilities of plan members.

E27, E28 Effective communications that make plan members aware of their rights and responsibilities.

E27, E28 Information that clearly informs plan members about services, benefits, and how the plan works.

E27, G37 Processes that protect the confidentiality of information and medical records of plan members.

E28 Accurate and thorough information about the health plan to prospective members. The SBHCs must be integrated into the school’s health program.

ACCESS (CONTINUED)

SERVICE

D24 (partially) Policies that ensure that the drugs the health plan covers are safe and effective and that plans give members the right to appeal for coverage of drugs not normally covered.

D23, D25 Evidence of improving members’ satisfaction with the health plan.

A6, E27 Processes for the coordination of care so that plan members receive the right care at the right time.

D23

Health plan members’ reports about how difficult it is for them to get needed care;

specifically, how much of a problem did members have getting a personal doctor they are happy with, a referral to a specialist, care they thought was necessary, and approvals for care.

D23 Health plan members’ reports about how often they experienced courteous, respectful, and helpful staff at the doctor’s office.

D23

Health plan members’ opinions about how difficult it was for them to good get customer service; specifically, how much of a problem did members have finding or understanding written information, getting help from customer service, or completing paperwork from the health plan.

not applicable Health plan members’ reports about how often their health plan paid claims in a reasonable time and correctly.

D23 Health plan members’ ratings of all their experiences with their health plan.

D22 A well-defined program for continuously improving the quality of clinical care and service provided to plan members.

D22 Individuals in the health plan responsible for overseeing quality improvement programs.

D22, D25 Actual improvements that the health plan has made in care and service.

25M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

SERVICE (CONTINUED)

D23 Health plan members’ reports received care quickly; advice, prompt care.

26 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

QUALIFIED PROVIDERS

Maine Standard reference NCQA Evaluation Element

C15, C20 Policies to effectively assess the qualifications of doctors and other providers who care for plan members.

no A committee of doctors who select and evaluate the plan’s doctors and other providers.

C15 Evidence that the health plan verifies doctors’ training, licensure, and certification.

C15, C20 Evidence that doctors disclose any information that affects their ability to practice medicine.

A2, C15, C20 On-site review of doctors’ offices by the health plan to ensure offices are accessible and adequate evidence of periodically reexamining doctors’ training, licensure, and certification.

C15, C18, C20 Evidence of periodically looking for information on any malpractice suits or sanctions.

C18 Evidence of evaluating experience with doctors and other practitioners, including information from plan members.

A2, C15, C18, C20

A process for periodically conducting an on-site review of doctors’ offices by the health plan, continuous review of doctors’ sanctions, licensure, and patient complaints.

C19 A process for suspending or removing doctors when necessary.

no Evaluations of the quality of hospitals, nursing homes, and home health agencies affiliated with the health plan.

D22 A well-defined program for continuously improving the quality of clinical care and service provided to plan members.

D22 Commitments from doctors that they will cooperate with health plan efforts to improve quality.

G37 Policies that require doctors to keep medical records in a way that maintains patient confidentiality and promotes effective patient care.

G38, G39 Complete and proper documentation of information in medical records.

D23 Health plan members’ ratings of doctors’ communication; specifically, how often did their doctor listen carefully, explain things, show respect, and spend enough time with them.

D23 Health plan members’ ratings of all health care received from their doctors and other health providers in the plan.

D23 Health plan members’ ratings of their personal doctor or nurse.

D23 Health plan members’ ratings of the specialist they saw most often.

D22 A well-defined program for improving the quality of clinical care and service provided to plan members.

D22 Individuals in the health plan responsible for overseeing quality improvement programs.

D22, D25 Actual improvements that the plan has made in care and service.

STAYING HEALTHY

Maine Standard reference NCQA Evaluation Element

B10, D24 The presence of guidelines for doctors about the need to provide immunizations and screening tests to plan members.

D24 Effective communications that make doctors in the plan aware of the guidelines.

B10 Effective communications that make plan members aware of what they can do to reduce illness, disease, and accidents.

not applicable The percentage of children under the age of two who have received recommended immunizations to prevent childhood diseases.

B10, D24 The percentage of children who, by the age of 13, have received recommended immunizations for the continued protection against childhood diseases.

not applicable The percentage of Medicare members over the age of 65 who received an influenza vaccination to prevent the flu (only for health plans serving Medicare beneficiaries).

27M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

QUALIFIED PROVIDERS (CONTINUED)

28 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

STAYING HEALTHY (CONTINUED)

Maine Standard reference NCQA Evaluation Element not applicable The percentage of women ages 52–69 who received a mammogram within the past two years to detect breast cancer early.

B10 (not explicit) The percentage of adult women who received a Pap smear within the past three years to detect cervical cancer early.

not applicable The percentage of pregnant women who received their first prenatal care visit during the first three months of pregnancy.

not applicable The percentage of new mothers who received a checkup within eight weeks after delivery.

D22 A well-defined program for improving the quality of clinical care and service provided to plan members.

D22 Individuals in the health plan responsible for overseeing quality improvement programs.

D22, D25 Actual improvements that the plan has made in care and service.

GETTING BETTER

Maine Standard reference NCQA Evaluation Element

B10, D22 The percentage of adults who smoke and were advised by their doctor to quit.

D22 A well-defined program for improving the quality of clinical care and service provided to plan members.

D22 Individuals in the health plan responsible for overseeing quality improvement programs.

D24 Distribution of guidelines that assist doctors with providing the right care to plan members with acute conditions.

D26 Evidence of monitoring the quality of care provided to plan members with specific acute conditions.

D25, D26 (not specific)

Evidence that the health plan is working to improve the quality of care provided to plan members with specific acute conditions and correcting any problems of poor quality.

D22, D25 Actual improvements that the plan has made in care and service.

29M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

LIVING WITH ILLNESS

Maine Standard reference NCQA Evaluation Element

B13 Active efforts to improve the health of plan members with chronic conditions.

D26 (not specific) The percentage of plan members with diabetes who received eye exams to detect blindness, a complication resulting from diabetes, early.

B12, D22 (not explicit)

The percentage of plan members, hospitalized for a mental illness, who were seen by a provider within 30 days of hospital discharge.

not applicable The percentage of plan members who had a heart attack and received beta blockers, a medication that helps prevent future heart attacks.

B12, D22 (not explicit)

The percentage of plan members who were diagnosed with a new episode of depression, treated with antidepressant medication, and had subsequent follow-up visits to ensure recovery through proper dosage.

not applicable The percentage of plan members treated for an acute cardiovascular event, who received a follow-up cholesterol screening in the next year.

D24 (partially) Policies that ensure that the drugs the health plan covers are safe and effective and that plans give members the right to appeal for coverage of drugs not normally covered.

D22 A well-defined program for improving the quality of clinical care and service provided to plan members.

D22 Individuals in the health plan responsible for overseeing quality improvement programs.

D24 Distribution of guidelines that assist doctors with providing the right care to plan members with chronic conditions.

D25, D26 Evidence of monitoring the quality of care provided to plan members with specific chronic conditions.

D25, D26 Evidence that the health plan takes action to improve the quality of care provided to plan members with specific chronic conditions.

D22, D25 Actual improvements that the plan has made in care and service.

31M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

AP P E N D I X I I

NATIONAL PRINCIPLES AND GOALS FOR SCHOOL-BASED

HEALTH CARE

NATIONAL ASSEMBLY ON SCHOOL-BASED HEALTH CARE – 2000

Cross-referenced with Maine SBHC Standards

In 2000, the National Assembly on School-Based Health Care created Principles and Goals for School-Based Health Care in order to set a national standard for the field, provide guidelines by which to benchmark programs, define essential elements of a school-based health center, and provide a framework for accountability and continuous improvement.

There are seven principles.

Maine Standard reference NASBHC Goal

E29, E32 Understands and respects accountability within the educational system.

A1, A3, E29 Works with the school administration to develop and achieve a shared vision.

A3, A6, E28 Communicates the vision to all school constituencies including teachers, support staff, students, and parents.

E Builds collaborative and mutually respectful relationships with school personnel.

A4, E28 Identifies community resources that provide support to students and promote successful learning.

E29 Serves as a resource in times of school crises and community disasters.

SUPPORTS THE SCHOOL

The school-based health center is built upon mutual respect and collaboration between the school and the health provider to promote the health and educational success of school-aged children.

32 M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

RESPONDS TO THE COMMUNITY

The school-based health center is developed and operates based on continual assessment of local assets and needs.

Maine Standard reference NASBHC Goal

A4 Assesses child and adolescent health care needs and available resources in the community through formal evaluation methods.

E28 Informs the community of student health needs and trends.

A1, A4, E28 Solicits community input to address unmet health needs and support the operations of the program.

FOCUSES ON THE STUDENT

Services involve students as responsible participants in their health care; encourage the role of parents and other family members; and are accessible, confidential, culturally sensitive, and developmentally appropriate.

Maine Standard reference NASBHC Goal

F34, F36 Encourages the student’s active, age-appropriate participation in decisions regarding health care and prevention activities.

F34, F36 Involves the parents or other adult caregivers as supportive participants in the student’s health care whenever appropriate and possible.

G, G37 Ensures confidentiality of information whether transmitted through conversation, billing activity, telemedicine, or release of medical records.

A5 Provides services and materials that are culturally sensitive and respectful of family values and diversity.

33M A I N E S C H O O L - B A S E D H E A LT H C E N T E R S S T A N D A R D S

DELIVERS COMPREHENSIVE CARE

An interdisciplinary team provides access to high quality, comprehensive physical and mental health services emphasizing prevention and early intervention.

Maine Standard reference NASBHC Goal

A4, B

Provides a scope of services that is consistent with identified health care needs. Services may include, but are not limited to: age-appropriate well-child exams, immunizations, diagnosis and treatment of acute illness and injury, management and monitoring of chronic conditions, basic laboratory services, capability to prescribe commonly used medications, health education and anticipatory guidance, basic mental health services, substance abuse services, violence prevention education and intervention counseling, and preventive and primary dental care.

A6* Promotes availability of on-site services whenever the school is open and facilitates after-hours care 24 hours a day, seven days a week.

D24…