Facing challenges for access to care through school based health centers: A case study from Chicago

The Illinois Coalition for School Based Health Centers reports that Illinois invested more than $50 million in school based health centers since 1985 to improve access to care for nearly 82,000 youth. The annual funding remains static however and threatens sustainability of existing centers with new centers promised across the state. The purpose of this presentation is to outline sustainability efforts for two centers and demonstrate the impact on clinic enrollment, volume of services, and immunization rates. In spring 2005, the two centers faced a deficit with staffing patterns at each site of a nurse practitioner, social worker, medical assistant and medical secretary and part-time pediatrician. The decision was made to redesign the staff pattern at each clinic to combine roles of several staff into the role of the public health nurse and volunteers changing from 8.15 Full Time Equivalents (FTE) to 4.65 FTE. After one year, data show that enrollment increased from 2773 students at the two sites to 3081 students representing nearly full enrollment of the schools' population. Encounters remained approximately the same with 2819 in fiscal year 05 and 2838 in fiscal year 06. Immunization rates were over 95% before and after the restructuring. While data show the staffing changes had minimal impact on basic services the minimal staffing pattern however, limits the development of other necessary services. Strategies to address staffing impact on student health outcomes will be discussed.