APPENDIX G-3
Connecticut School Health Services Models

State of Connecticut, Department of Public Health and Addiction Services

STANDARD MODEL FOR INCREASED BASIC SERVICES SCHOOL AND ADOLESCENT HEALTH SERVICES-LEVEL II

  1. The scope of services at this level does not require an outpatient clinic license.

  2. The Increased Basic School Health Services Model must enhance existing basic school health services. These services should be available on a regular basis during the academic year. Extended hours beyond the regular school day are encouraged, when possible.

  3. . Staff should be efficient and appropriate to carry out the services of the project. Project activities must complement the school's responsibilities and programs but not substitute for or replace them. Staff may include but is not limited to social worker (MSW); bachelor's-prepared registered nurse (BSN); certified health educator; allied health professional (medical assistant, community educator, outreach worker, parent aide, clerical staff, etc.).

  4. Health and mental health services

    1. Health services must be provided in accordance with nationally recognized and accepted standards, such as the American Acad-



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School & Health: Our Nation's Investment APPENDIX G-3 Connecticut School Health Services Models State of Connecticut, Department of Public Health and Addiction Services STANDARD MODEL FOR INCREASED BASIC SERVICES SCHOOL AND ADOLESCENT HEALTH SERVICES-LEVEL II The scope of services at this level does not require an outpatient clinic license. The Increased Basic School Health Services Model must enhance existing basic school health services. These services should be available on a regular basis during the academic year. Extended hours beyond the regular school day are encouraged, when possible. . Staff should be efficient and appropriate to carry out the services of the project. Project activities must complement the school's responsibilities and programs but not substitute for or replace them. Staff may include but is not limited to social worker (MSW); bachelor's-prepared registered nurse (BSN); certified health educator; allied health professional (medical assistant, community educator, outreach worker, parent aide, clerical staff, etc.). Health and mental health services Health services must be provided in accordance with nationally recognized and accepted standards, such as the American Acad-

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School & Health: Our Nation's Investment emy of Pediatrics school health manual, School Health: Policy and Practice (American Academy of Pediatrics Committee on School Health, 1993), or those of the National Association of School Nurses. The standards to be used must be clearly identified in the project application. Mental health services must be provided in accordance with a nationally recognized and accepted standard, such as the National Association of Social Workers Guidelines for School Settings. The standards to be used must be clearly identified in the project application. Examples of possible increased or additional services include the following: Health maintenance and promotion Nursing assessments, nursing diagnosis, and EPSDT screenings Support or educational groups for students with chronic conditions (e.g., asthma, diabetes) Consultation with school staff and parents Referral and follow-up for specialty services that are beyond the scope of mandated school health services Crisis intervention Individual, family, and group counseling and referral Outreach to students at risk, including those in jeopardy of dropping out or who have recently dropped out Support and/or psychoeducational groups focusing on topics of importance to the target population (pregnancy prevention, grief, conflict resolution skills, etc.) Training for school health services staff (through regular consultation, clinical supervision, or additional education) Individual and group health education Home visits or early intervention Linkages with the community; Establishing linkages with medical, mental health, social service providers, and other relevant groups is encouraged. These may include the local health department, community health center, medical schools and hospitals, and schools of public health, mental health and family service agencies, youth service bureaus, and recreational agencies.

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School & Health: Our Nation's Investment The administration of these increased services must be integrated with the current administration (i.e., additional nursing services should be supplied by the same agency that currently supplies nursing services to the school). Should subcontractors with community agencies be utilized, a plan for project and administrative integration with existing school-based services must be clearly outlined. STANDARD MODEL FOR ENHANCED CLINICAL SERVICES SCHOOL AND ADOLESCENT HEALTH PROGRAM-LEVEL III A project at this level may be required to hold a State of Connecticut license for outpatient clinics as outlined in the Public Health Code, Sections 19-13-D45 through 19-13-D53. The scope of services offered will dictate whether or not a license would be required. The enhanced clinical services should be available on a regular basis during the academic year. Extended hours beyond the regular school day are encouraged, when possible. Specific plans for the provision of services and continuity of care during nonoperational times must be clearly outlined. Staff should be appropriate to carry out the services of the project. A project coordinator or manager must be identified. Staffing may include health and/or allied health professionals as needed (e.g., pediatric, family or psychiatric nurse practitioner, pediatric or family physician assistant, social worker, nutritionist, substance abuse prevention specialist, certified health educator, outreach worker, parent aide, clinical psychologist, M.D., dentist, dental hygienist, clerical support. Certain services may require written parental permission. Services may include but not be limited to the following: Health or physical services, must be provided in accordance with nationally recognized and accepted standards, such as the American Academy of Pediatrics school health manual, School Health: Policy and Practice (American Academy of Pediatrics Committee on School Health, 1993), or those of the National Association of School Nurses. The standards to be used must be clearly identified in the project application.

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School & Health: Our Nation's Investment Primary health care, including the following: Physical exams, health assessments, and screening for health problems. Diagnosis and treatment of acute illness and injury Diagnosis and management of chronic illness Immunizations Health promotion and risk reduction Nutrition and weight management Reproductive health care Laboratory tests Prescription and/or dispensing of medication for treatment Prenatal and postpartum referral and follow-up Adolescent pregnancy prevention and parenting services Referral and follow-up for specialty services that are beyond the scope of services provided by this project Mental health or social services must be provided in accordance with nationally recognized and accepted standards, such as the National Association of Social Workers Standards for Social Work in Health Care Settings. The standards to be used must be clearly identified in the project application. Assessment and treatment of psychological, social, and emotional problems Crisis intervention Individual, family, and group counseling or referral for same, if indicated Substance abuse and HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) prevention, risk reduction, and early intervention services Support and/or psychoeducational groups focusing on topics of importance to the target population Advocacy and referral for such services as day care, housing, employment, and job training Referral for students requiring long-term or residential treatment Consultation with school staff and parents on issues of child and adolescent development Health education services (complementary to the curriculum provided by local education agencies)

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School & Health: Our Nation's Investment Consultation with school staff regarding issues of growth and development School staff and parent training regarding issues of importance to target population Individual and group health education Dental services, including the following: Screenings and cleanings Sealant applications Treatment for caries or extractions Referral and follow-up for services beyond the scope of the project Linkages with the community: Establishing linkages with medical, mental health, social service providers, and other relevant groups is encouraged. These may include the local health department, community health center, medical schools and hospitals, schools of public health, mental health and family service agencies, youth services bureaus, and recreational agencies. . The administration of these clinical services may need to be distinct from the administration that currently exists, depending on the scope of services provided. The rationale and design of the administrative structure must be clearly outlined in the proposal. A plan for how these new services will integrate with existing school-based services must be described. STANDARD MODEL FOR PART-TIME COMPREHENSIVE SCHOOL-BASED HEALTH CENTER-LEVEL IV A part-time school-based health center (SBHC) is similar to a full-time SBHC and closely follows the Level V Standard Model for a comprehensive SBHC. A school would be eligible for a part-time SBHC if the student body is less than 500. The administration and coordination of the part-time SBHC must emanate from a full-time SBHC. The part-time SBHC must hold a State of Connecticut license for outpatient clinics as outlined in the Public Health Code, Sections 19-13-D45 through 19-13-D53. The part-time SBHC should operate regularly at specified times during the academic year:

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School & Health: Our Nation's Investment It should be open September through June (excepting weekends, holidays, and school vacations). It should be open specific hours during school operation. Extended hours may be appropriate to increase access. Solid plans for the provision of services during nonoperational times must be clearly identified. Medical and social services ''backup" must be clearly defined (with letters of agreement) to cover medical and psychiatric emergencies and other needed services during times the center is not open (i.e., after school hours, weekends, holidays, vacations). Ideally, the center staff would have privileges at the backup site(s) in order to enhance continuity of care for the target population. Administration and coordination must be under the direction of the full-time SBHC with which it is affiliated. Staff should be sufficient to provide services for the number of hours the SBHC is to be open and should include the following: A center coordinator or manager responsible for the full-time SBHC with which the part-time SBHC will be affiliated A nurse practitioner who must have experience serving the target population (including age and ethnicity), with clinical supervision or consultant backup A social worker (MSW) who must have experience in working with the target population (including age and ethnicity), with clinical supervision or consultant backup Additional health and/or allied health professionals as needed (e.g., nutritionist, substance prevention specialist, health educator, outreach worker, parent aid, psychologist, dentist, dental hygienist Clerical support Utilization of center services requires written parental permission.

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School & Health: Our Nation's Investment Physical health or medical services must be provided in accordance with such standards as the American Academy of Pediatrics Guidelines for Health Supervision. Other nationally recognized and accepted standards may be used as a framework for professional practice with prior department approval. Primary health care, including the following: Physical exams, health assessments or screening for health problems Diagnosis and treatment of acute illness and injury Diagnosis and management of chronic illness Immunizations Health promotion and risk reduction Nutrition and weight management Reproductive health care Laboratory tests Prescription and/or dispensing of medication for treatment Prenatal and postpartum referral and follow-up Referral and follow-up for specialty services that are beyond the scope of services provided by this project Mental health or social services must be provided in accordance with nationally recognized and accepted standards, such as the National Association of Social Workers Standards for Social Work in Health Care Settings. Other nationally recognized and accepted standards may be utilized as a framework for professional practice with prior department approval. Assessment and treatment of psychological, social, and emotional problems Crisis intervention Individual, family, and group counseling or referral for same, if indicated Substance abuse and HIV/AIDS prevention, risk reduction, and early intervention services Outreach to students at risk Support and/or psychoeducational groups focusing on topics of importance to the target population Advocacy and referral for such services as day care, housing, employment, and job training

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School & Health: Our Nation's Investment Referral for students requiring long-term or residential treatment Consultation with school staff and parents on issues of child and adolescent development Health education services should be supportive of existing health education activities of local education agencies. Consultation with school staff regarding issues of growth and development School staff and parent training regarding issues of importance to target population Individual and group health education Classroom presentations Linkages with the community: Establishing linkages with medical, mental health, social service providers, and other relevant groups is encouraged. These may include the local health department, community health center, medical schools and hospitals, schools of public health, mental health and family service agencies, youth services bureaus, and recreational agencies. STANDARD MODEL FOR A FULL-TIME COMPREHENSIVE SCHOOL-BASED HEALTH CENTER-LEVEL V The school-based health center must hold a State of Connecticut license for outpatient clinics as outlined in the Public Health Code, Sections 19-13-D45 through 19-13-D53. The SBHC should operate full-time during the academic year, according to the following schedule: It should be open September through June (excepting weekends, holidays, and school vacations). It should be open specific hours during school operation. Extended hours are encouraged when possible. Solid plans for the provision of services during nonoperational times must be clearly identified. Medical and social services back-up must be clearly defined (with letters of agreement) to cover medical and psychiatric emergen-

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School & Health: Our Nation's Investment cies and other needed services during times the center is not open (i.e., after school hours, weekends, holidays, vacations). Ideally, the center staff would have privileges at the backup site(s) in order to enhance continuity of care for the target population. Staff should be sufficient to operate a full-time SBHC (as defined in part I of this section) and should include the following: A center coordinator or manager with training and experience in health or mental health systems management, supervision, and administration At least one nurse practitioner who must have experience serving the target population (including age and ethnicity), with M.D. backup At least one social worker (MSW) with expertise in working with the target population (including age and ethnicity), with clinical supervision or consultant backup Additional health and/or allied health professionals as needed (e.g., nutritionist, substance prevention specialist, health educator, outreach worker, parent aide, psychologist, dentist, dental hygienist) Clerical support Utilization of center services requires written parental permission. Minimum services to be provided include the following: Physical health services must be provided in accordance with nationally recognized standards, such as the American Academy of Pediatrics school health manual School Health: Policy and Practice (American Academy of Pediatrics Committee on School Health, 1993), or those of the National Association of School Nurses. The standards to be used must be clearly identified in the project application. Primary health care, including: Physical exams, health assessments or screening for health problems

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School & Health: Our Nation's Investment Diagnosis and treatment of acute illness and injury Diagnosis and management of chronic illness Immunizations Health promotion and risk reduction Nutrition and weight management Reproductive health care Laboratory tests Prescription and/or dispensing of medication for treatment Prenatal and postpartum referral and follow-up Adolescent pregnancy prevention and parenting services Referral and follow-up for specialty services that are beyond the scope of services provided by the SBHC Mental health services must be provided in accordance with a nationally recognized and accepted standard such as the National Association of Social Workers (NASW) Standards for Social Work in Health Care Settings. The standards to be used must be clearly identified in the project application. Assessment and treatment of psychological, social, and emotional problems Crisis intervention Individual, family, and group counseling or referral for same, if indicated Substance abuse and HIV/AIDS prevention, risk reduction, and early intervention services Outreach to students at risk Support and/or psychoeducational groups focusing on topics of importance to the target population Advocacy and referral for such services as day care, housing, employment, and job training Referral for students requiring long-term or residential treatment Consultation with school staff and parents on issues of child and adolescent development. Health education services (complementary to the curriculum provided by the local education agencies) Consultation with school staff regarding issues of growth and development

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School & Health: Our Nation's Investment School staff and parent training regarding issues of importance to target population. Individual and group health education. Dental services, including the following: Screenings and cleanings Sealant applications Treatment for caries or extractions Referral and follow-up for services beyond the scope of the project Linkages with the community: Establishing linkages with medical, mental health, social service providers, and other relevant groups is encouraged. These may include the local health department, community health center, medical schools and hospitals, schools of public health, mental health and family service agencies, youth services bureaus, and recreational agencies. REFERENCE American Academy of Pediatrics Committee on School Health, 1993. School Health: Policy and Practice, Nader, P.R. (ed), American Academy of Pediatrics, Elk Grove Village, IL.