Service Specifications for SBHC

1.Definition:

1.1 Background[1]:

Results from the nation-wide Youth 2000 survey of 10,000 New Zealand secondary school students showed that while the majority of young people are healthy, a significant number of students engage in behaviours that threaten their health, such as unsafe sexual activity, suicide attempts and substance abuse.[2] It is of particular concern that half of the students surveyed identified barriers to accessing healthcare.[3]

These barriers could typically be categorised in two ways: external (health provider issues) and internal (young person issues). External issues include not feeling comfortable with the health provider and concerns regarding privacy. Internal issues include not wanting to make a fuss, the effort involved in attending health services, and/or being scared. School based healthcare has the potential to address some of these identified barriers.

The benefits of having accessible, high quality primary health care are considerable. The health outcomes of communities are improved and people feel better about the healthcare they receive.[4] Accessible and appropriate primary health care services also have the potential to enhance educational outcomes by improving the physical and mental health of a student, thereby removing barriers to learning[5]

Appropriate primary care services can also promote long-term health by encouraging the avoidance of behaviours that have serious health consequences in adulthood. In addition, maturing adolescents can be seen as “new patients” who are learning to navigate the health system for themselves.[6] This is an important step towards students taking long-term responsibility for their own health , School based health services, especially when working in partnership with health curriculum teaching in the classroom, has the potential to facilitate lifelong healthy behaviours.

1. 2. Philosophy:

Youth Development Philosophy[7] Appendix 1

This development mode has been written and prepared by Youthline for a Youth Development Model in schools. The mission is to enhance the wellbeing of young people and the outcomes are:

Youth services, groups, clubs will work collaboratively to foster the development of young people.

Young people are connected with community leaders and projects, and participate in community decisions and processes
Young people have positive and strengths based relationships with peers, whanau/ family, school and the wider community.
Young people have positive experiences of being themselves and being welcomed and accepted as valued members of the community.
Young people have accurate and unbiased information, resources and support from peers, family./ whanau and significant others to assist their decision making
Young people have a strong sense of self and are connected to their cultural identity
Young people are able to express their diverse and holistic needs and have these acknowledged and supported.
Young people have opportunities to develop themselves as leaders of self and others through development pathways.

2.Service Objectives:

To improve educational outcomes by overcoming health and social barriers to learning for young people in <school>.

By improving access to health and social services for <school> students
By formally assessing every year nine student with the HEADSS assessment[8] and providing follow- up to ensure appropriate intervention or support.
By providing opportunistic screening of all students with the HEADSS assessment and ensuring follow-up for appropriate intervention and support.
By enhancing student’s strengths and minimising risks
By developing appropriate referral processes and enable service shifts on school sites.
By facilitating the development of school based services based on students needs e.g. services for mental health; drug and alcohol; nutrition, weight and exercise and sexual health
By reducing unplanned pregnancies, reducing incidence of STIs, screening for asthma, diabetes and mental health; vision and hearing and child protection

This will be done by

Wide engagement with school and community
Ensuring youth focus and participation
Delivery of high quality comprehensive care
Effective administrative / clinical systems and governance to support service delivery.

2. 1 Maori Health

All school based health services will contribute to reducing inequalities. This will be achieved by CMDHB focusing on schools with high populations of Maori students, Pacific students and students from low socio-economic areas. All services provided will be provided in a culturally competent style.

3. Service Users:

Young people between 12 and 18 years who live within the geographical area serviced by <school> and or students who attend <school>. (Students excluded from this school are excluded from this service)

The number of students currently attending <school> is:<number>

The Number of Year nine students currently attending <school> is:<number>

4. Access:

The service will be provided between 8 and 4pm during the school terms.

Young people can access the clinic - in accordance with school policies.

All Year nine students should be formally and comprehensively assessed.

The main principle is to provide easy access appointments for students with the minimum disruption to the student’s education.

5. Service Components

5.1 Wide Engagement with school and community1

Early formation of an advisory board with community and school representation. The advisory board should reflect the diversity of the school community.
Consultation within the school including Principal, staff, school pastoral team; Board of Trustees; student and parents. Consultation beyond the school including Iwi; Pacific community groups; PHOs and local GPs.
Stocktake of existing services in the school and wider community. On-going co-ordination and integration with these services
Mutually agreed role and responsibilities of each party- the school and the school- based health service- drafted into a formal agreement. This should include references to relevant school policies, financial arrangement, facilities to be provided by the school, key contact people for each organisation, liability coverage of each party and reporting requirements. Appendix 2
Commitment to communication on a regular basis between all staff providing health and support services in the school. This would include both case review (usually fortnightly or weekly) and service development meetings (e.g. quarterly)
Heath service personnel aware of the school’s health curriculum and available to contribute where requested.
Health staff working closely with education staff to identify and assist those students with issues influencing their educational performance.
Work with current school initiatives that promote a youth development and youth supportive philosophy- e.g. Restorative Justice; Rock and Water and Drug Free Contracts.
On-going communication with the school and the wider community e.g. presentations at school assemblies, involvement in health classes, presence of staff at school meetings, newsletters and visits for new students.

5.2 Youth Focus and participation

All school- based health services have or utilise a youth advisory group
Known youth health access issues addressed including:
Youth friendly staff that genuinely respect and enjoy working with young people.
Appropriate location of the service
Operating hours appropriate for the needs of the students where possible available over lunchtime
Confidentiality policies displayed clearly in the waiting room and personally reiterated by healthcare providers in their clinical contacts
A youth friendly version of the Patient Code of Rights on display Appendix 3

Strategies to help raise both student and parent awareness of available services and how to access them. Information should be provided in languages and in cultural settings appropriate to the school community.
Linkages developed with peer support health initiatives in the school. For instance involving peer supporters in the heath services (with adequate training, supervision and clear roles)

5.3 Delivery of high quality comprehensive care

Cultural issues considered and addressed strategically operationally and clinically. This includes enhancing cultural competence of staff and supporting student’s connection to their own cultures.
Staff providing the school- based services maintaining their own specific professional development and competencies, and regular supervision. In addition staff should have appropriate training in youth health. For clinical leaders this should include holding or working towards a postgraduate qualification in youth health.
Given the potential for complex nursing judgements to be required in the school setting, all nurses working independently in the school setting should be fully registered nurses.
Staff have dedicated time and resource available for collaboration, professional development, quality and related policy issues. Supervision will be provided for nurses for the 2006/2007 year, but the school will be responsible for ensuring on-going clinical supervision following that period.
Comprehensive opportunistic screening for important adolescent health issues offered to all young people receiving cares. In liaison with local primary care providers, consideration should also be given to offering regular health check ups.Appendix 4
Screening, assessment and primary care level mental health services provided on site. Ready access to further mental health services where necessary.
Local guidelines for relevant clinical practice adopted, along with establishment of a medical protocol ad procedures manual. Appendix 5
Mechanisms and processes for the exchange of medical information (with student permission) between school-based providers and other services, such as pastoral team, student’s family doctor or nurse and referral agencies.
Provision and dispensing of medicines for common medical problems should be preferable on site with secure storage of medications. Alternatively, School Based Health Services should arrange for medications to be available free or at a subsidised rate from a nearby pharmacy.
Where a doctor is not on site or only infrequently, consideration of the use of standing orders. These may be arranged with local primary medical health care providers to allow dispensing of some medications by appropriately trained staff.Appendix 6
Examination and treatment areas comply with standard infection control and safety regulations.
Staff trained in general first aid, including regular CPR updates. An emergency plan with appropriate equipment and drugs for emergencies is available and regularly checked for expiry.

5.4 Effective administrative / clinical systems and governance to support service delivery

A functioning oversight committee operating with sound business procedures and based on the Treaty of Waitangi framework consistent with the New Zealand Health strategy.
Appropriate written policies on consent,Appendix 7confidentiality, .Appendix 8collection and use of health information, and protection of records. Appendix 9 These must be in line with the New Zealand Public Health and Disabilities Act 2000, and the Health information Privacy Code 1994.
Systems to promote screening and appropriate documentation of care, along with tracking missed and follow-up appointments and laboratory and referral reports. Appendix 10
A professional development strategy recognising the needs for quality primary care provision in addition to youth specific issues.
A system for gathering data on key indicators of quality youth health services
Monitoring and evaluating appropriate needs and accessibility of services with regular surveys of students/ school/ community
Service development based on periodic review of data.

Specific Service Components

Registered Nurse

Comprehensive assessments of all Year nine students
Opportunistic assessments of all Year 10- 14 students.
Follow up- based on identified need.
Systematic development of initiatives to address student need.
Analytical review of services annually.

Staff competencies:

There are standards available for school nursesAppendix 11 Youth workers.Appendix 12

There are registered nurses job descriptions and enrolled nurses (working on site with a registered nurse) available.Appendices 13 and 14

6. Service Linkages:

Students at the school / To obtain youth expert opinion
Parents of students / To liaise and link and ensure parental input into service as appropriate.
School management and staff / To ensure continued support and interface with relevant educational activities.
<school> Board of Trustees. / To ensure Governance is aware of and supportive of school health activities
Other educational initiatives- e.g. Truancy; Alternative Education; NETs; Group Special Education. / To achieve a continuum of care and support similar activities.
Other AIMHI and decile 2 schools. / To ensure continued support and interface with relevant educational activities.
Primary healthcare - local PHO / To ensure continued support and interface with relevant educational and health activities.
Other youth providers / To ensure continued support and interface with relevant educational and health activities.
On-site dental services / To ensure continued support and interface with relevant educational and health activities.
Referral services for sexual, mental, dental services and physical health. / To ensure continued support and interface with relevant educational and health activities.
Public Health Nurses / To ensure continued support and interface with relevant educational and health activities.
Health Promoting Schools / To ensure continued support and interface with relevant educational and health activities.
Maori services / To ensure continued support and interface with relevant educational and health activities.
Pacific services / To ensure continued support and interface with relevant educational and health activities.
Welfare support services including CYFs / To ensure continued support and interface with relevant educational health and other relevant sectors activities.
Police / To ensure continued support and interface with relevant educational health and other relevant sectors activities.
WINZ / To ensure continued support and interface with relevant educational health and other relevant sectors activities.

7.Exclusions:

Students in alternative education or teen Parent Units.

Students who have been excluded from school and are not allowed on the grounds.

8. Quality:

Appendix 15Standards for Youth Health Services.

Reporting requirements:

An annual report submitted in Feb. 2007

This report will contain:

A report against the audit tool enclosed (appendix 15). This is based upon Best Practice. This report will also include strategic plans and responses to improving access; acceptability; ensuring safety and demonstration of how efficient and effective the service is.

A report against the AIMHI reporting framework, (which can be produced by the database). This contains:

- Year 9 roll and number of Year 9 students assessed.

- Years 10- 14 roll and number of assessments and visits.

- Number of students Year 9 and school) referred to

Primary Healthcare

Mental health

Dental health

Drug and alcohol

Sexual health

BMIs- underweight; normal; overweight; obese and average.

Vision referrals

Hearing Referrals

Other referrals

Referrals to Guidance Counsellor

Referrals to school social workers/ community workers

Referrals to CYFs.

- Report on barriers to referrals.

- Overview of analysis of trend of service needs and provision.

- Training undertaken by staff.

- Provision of annual plan for School Based Health Services.

Appendices:

Youthline: Youth Development Philosophy (currently in draft- available )
Example MoU between schools and providers (currently in draft- available )
Youth friendly Code of rights (to be developed 2006 by Youth Advisory group)
AIMHI assessment tool- based on HEADSS model
Protocols developed by School Nurses Group
Standing orders under development- Primary health team and School Nurses Group.
Policies on consent- (currently in draft - available )
Policies on confidentiality and information sharing (currently in draft - available )
Policies on sexual health in schools (available now)
Data base information available on a purpose built data based design to store and report on the Assessment tool.
Standards for Youth Health Services from Centre for Youth Health (currently in draft - available)
Standards for Youth Workers from Youthline (currently in draft - available )
Registered Nurse Job Description available from School Nurses Project
Enrolled Nurse Job Description (working with a Registered Nurse on site) available from School Nurses Project
Standards for Youth Health from Centre for Youth Health (currently in draft - available )

This service specification has been developed from information from Centre for Youth Health and Youthline.

Contracts – Service SpecificationsPage 1 of 8

[1]This information has been copied from the “Successful School Health Services for Adolescents- Best Practice Review”- KidzFirst Community Health- Centre for Youth Health; May 2005.

[2](Adolescent Health Research Group- New Zealand Youth: A profile of their health and wellbeing: Auckland University 2003). In particular students who are failing in education have exceptionally high healthcare needs (Denny S, Clark T, Watson P. The health of alternative education students compared to students attending secondary schools from New Zealand. New Zealand Medical Journal 2004; 117 (1200):8-11.)

[3](Adolescent Health Research Group- New Zealand Youth: A profile of their health and wellbeing: Auckland University 2003).

[4](Atun R. What are the advantages and disadvantages of restructuring a healthcare system to be more focused on primary care services? Denmark: WHO, Regional office for Europe: 2004))

[5](University of California Evaluation Team, Alameda County Health Care Service Agency. Alameda County School Based Health Centre Coalition Report, San Francisco ,CA. Institute for Health Policy Studies, University of California 2003.).

[6](Royal College of Paediatrics and Child Health: Bridging the Gaps: Healthcare for Adolescents UK: Royal College of paediatrics and Child Heath 2003))

[7]A Youth Development Model for Manukau- October 2005; Youthline.

[8]The HEADDS assessment is a holistic youth health and wellbeing assessment that covers the students risks and resiliencies; sexual health; physical health and history; drug and alcohol; family health; family relationships and peer relationships. There is a database available for schools to use to store their information and produce reports.