Jefferson County School Based Health Centers 212-213 Participation Report Background: School Based Health Centers (SBHCs) were established during the 28-29 school year to address a need for adolescent primary and mental health care in East Jefferson County. Currently there are SBHCs in Port Townsend High School (PTHS) and Chimacum High School (CHS) providing students at each school with two days 1 of medical and two days 2 of mental health care per week. The SBHCs are also available to middle and elementary school students, although younger students are more likely to utilize the SBHC at CHS because of the shared elementary, middle, and high school campus. There are additional mental health services available a few hours a week at Chimacum Middle School and Chimacum Elementary School and there are counselors providing mental health care only at Quilcene High School and Blue Heron Middle School. Each SBHC has an assigned nurse practitioner. For the first half of the 212-213 school year, there were two mental health counselors, one for each SBHC. A December staffing change resulted in the CHS counselor providing services to both PTHS 211-212 (May 212) and CHS students for the remainder of the school year. Medical services are funded by Jefferson County Public Health and Jefferson Healthcare. Mental health services are funded by the Jefferson County Mental Health/Chemical Dependency sales tax. Services are available regardless of insurance or ability to pay about 4 in 1 students at CHS and PTHS are low-income (see Free and Reduced Lunch rates table). Services focus on preventative care including immunizations, tobacco cessation, nutrition, eating and weight concerns, reproductive health care, physicals, and mental health counseling. Visits for injuries, illness, and infection are also common throughout the year. Free and Reduced Lunch Rates Chimacum School District 5.1 Chimacum Creek Primary 59.8 Chimacum Elementary 59. Chimacum Middle 44. Chimacum High School 4.9 Port Townsend School District 45.9 Grant Street Elementary 48.8 Blue Heron Middle School 54.2 Port Townsend High School 36. % Evaluation Methods: For every medical visit, data on student concerns, clinician addressed topics, and referrals were collected by the SBHC nurse practitioner. Demographic and health care access data were collected at each client s first visit by the AmeriCorps member serving in the SBHCs. For every mental health visit, data on student and clinician concerns was collected by the SBHC mental health counselors (results begin on page 7). Data in this report were collected from August 212 through June 213. 1 8 hours PTHS, 12 hours CHS 2 1 hours PTHS, 1 hours CHS 1 P a g e
# of clients SBHC Demographics The majority of students using the SBHCs are in 9 th grade and most are female. 3 25 2 15 Grade at First Visit # of clients CHS % of clients at first visit Gender PTHS CHS Female 63% 75% Male 37% 25% 1 5 # of clients PTHS 5 6 7 8 9 1 11 12 Grade The majority of clinic users are White, nearly 7% at PTHS and 75% at Chimacum. PTHS: Client Race White CHS: Client Race White 2% 1% 8% 6% 3% 2% 9% 69% Black/ African American Native Hawaiian/ Pacific Islander Asian Native American/ Alaskan Native Hispanic Mixed Other 3% 1% 2% 6% 6% 7% 75% Black/ African American Native Hawaiian/ Pacific Islander Asian Native American/ Alaskan Native Hispanic Mixed The majority of students at both CHS and PTHS live in married parent or guardian homes. More students at CHS, however, are living in single parent homes or in the homes of friends or family members. 23% 3% PTHS: Living Situation at First Visit 1% 5% 2% 66% Married parent/ guardian home Single parent/ Guardian home Friends/family Proctor House Host family 32% CHS: Living Situation at First Visit 7% 2% 1% 58% Married parent/ guardian home Single parent/ guardian home Friends/family Proctor House Foster care On own 2 P a g e
Average # of visits per day Average # of Visits per Clinic Day Average # of Visits per Clinic Day SBHC Clinic Usage PTHS Total visits: 375 Total # of clients: 143 CHS Total Visits: 377 Total # of clients: 144 Based on enrollment numbers, 41% of CHS students and 3% of PTHS students utilized SBHC physical health services during the 212-213 school year. 9 8 7 6 5 4 3 2 1 Port Townsend High School Medical Visits by Month Winter break 212 213 AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Month 375 total visits over 74.5 clinic days Note: clinic not open in July Summer Break 9 8 7 6 5 4 3 2 1 Chimacum High School Medical Visits by Month Winter break 212 213 AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Month 377 total visits over 76 clinic days Note: clinic not open in July Summer Break 1 8 Average SBHC Visits per Clinic Day Visits per Clinic Day CHS Visits per Clinic Day PTHS 6 4 2 AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Month 3 P a g e
PTHS: 11th graders had the greatest number of clients and total visits. CHS: 9th graders had the greatest number of clients but the most visits were by 1th graders. Both schools had an average of 2.6 visits per client with a range of 1 to 8 visits at PTHS and a range of 1 to 16 visits at CHS. Port Townsend High School Number of Visits and Clients by Grade Chimacum High School Number of Visits and Clients by Grade 125 125 1 1 75 75 5 5 25 25 5 6 7 8 9 1 11 12 5 6 7 8 9 1 11 12 Client Grade Total number of clients: 143 Clients without reported grade: 2 # of clients seen (unduplicated) total # of visits Client Grade Total number of clients: 144 Clients without reported grade: 7 # of clients seen (unduplicated) total # of visits Chimacum saw students in grades 5 through 12 while Port Townsend saw students in grades 7 through 12. Note: 12 th graders often spend less time on campus, carry fewer credits, and may participate in Running Start. The elementary, middle, and high school share a campus in Chimacum likely explaining the greater use by younger students. first visit PTHS first visit CHS total clients PTHS F M Males comprised 37% of new clients and 24% of total clients at PTHS, they % 2% 4% 6% 8% 1% accounted for 14% of total visits. 63% 75% 76% 37% 25% 24% At CHS males comprised 25% of new clients and 15% of total clients, they accounted for 15% of total visits. total clients CHS total visits PTHS total visits CHS 81% 86% 9% 15% 14% 7% Males comprised a greater percentage of first visits than total visits at both schools indicating that they had fewer repeat visits during the year. Gender Breakdown by First Visits, Unduplicated Total Clients, and Total Visits NOTE: CHS had 9 client visits with unreported gender 4 P a g e
SBHC Visit Reasons SBHC Top Ten Visit Reasons Depression Tobacco Immunizations Stress Drugs and alcohol Eating/weight School performance Family Relationships Reproductive health Student concern Clinician addressed 1 2 3 4 5 6 SBHC Top Ten Student Concerns Relationships Flu/cold Depression Injury Eating/weight Family Infection Immunizations Sports physical Reproductive health 1 2 3 4 5 6 Depression Tobacco Immunizations Stress Drugs and alcohol Eating/weight School performance Family Relationship Reproductive health SBHC Top Ten Issues Addressed by provider 1 2 3 4 5 6 The vast majority of visits at both clinics are for reproductive health which may include STI screening, pregnancy test, birth control, emergency contraception, and education on risky sexual behavior and harm reduction techniques. Likely due in part to the SBHCs, Jefferson County has the third lowest teen pregnancy rate in Washington State (Age 15-19. Source: WA State Dept of Health, 211 Vital Statistics. http://www.doh.wa.gov/dataandstatisticalreports/vitalstatisticsdata/abortionpregnancydata/abortionpregnancytablesbyyear.aspx.) Student athletes are required to get a sports physical every two years. Both SBHCs provide this service which is also available to Quilcene students. Before fall sports begin in August, both clinics open for four days to give students convenient and inexpensive access to sports physicals. According to data from the 212 Healthy Youth Survey (HYS), Jefferson County youth have higher rates than state average for current and lifetime alcohol use as well as binge drinking for 1 th and 12 th graders. They also report higher rates of current cigarette smoking, marijuana use, and substance use at school. 1 th graders report higher than state average for illegal drug use. Further, Jefferson County youth perceive that access to cigarettes, alcohol and marijuana is not very difficult and that most adults do not think youth drinking and smoking marijuana is very wrong (Source: 212 HYS). A third of 1 th graders and 12 th graders in Jefferson County reported experiencing depressive feelings in the past year. One in 4 1 th graders and one in five 12 th graders reported having seriously considered suicide in the past year (Source: 212 HYS). 5 P a g e
# of Visits # of Students SBHC Referrals Appropriate referrals for students are made on a consistent basis to a variety of providers and organizations. Common referrals from the SBHCs are for mental health services (SBHC MH counselor, as well as, in-patient, outpatient organizations), dental services (including the Smile Mobile), additional medical services, school counselor, chemical dependency programs, emergency housing and food, and juvenile services. SBHC Clinic Usage Over Time 3 Number of Clients Served at SBHCs Over Time # Clients PTHS # Clients CHS Total # Clients The total number of clients in 212-13 is similar to 211-12, but total visits decreased indicating fewer visits per client or a decrease in frequent clinic users. A schedule reduction due to a switch to EMR occurred this school year. Since the 29-1 school year, the number of clients seen at the SBHCs has increased 12%. 25 2 15 1 5 1 9 8 7 6 5 4 3 2 1 School Year Number of Visits per Year at SBHCs Over Time # Visits PTHS # Visits CHS Total # Visits School Year 6 P a g e
# of clients SBHC Mental Health Demographics The majority of students using MH services at Chimacum and Pt Townsend SBHCs are in 9 th grade, at Quilcene the majority are in 1 th grade. At all three schools, the majority are female although barely over half at Quilcene. Note: Demographics are missing from 27% of Chimacum, 19% of Pt Townsend, and 4% of Quilcene students using SBHC MH services. Race and living situation are not collected at MH visits. 12 1 8 6 4 2 Grade at First Visit Chimacum Pt Townsend Quilcene Gender % of clients at first visit Pt Chimacum Townsend Quilcene Female 78% 74% 52% Male 22% 26% 48% 1 4 5 6 7 8 9 1 11 12 Grade SBHC Mental Health Visits Chimacum had the highest number of visits and clients. Quilcene had the highest average number of visits per client and visits per day and the highest range. Port Townsend had the highest number of days when MH services were available. Quilcene had the highest proportion of enrolled 9-12 th grade students using MH services. Chimacum Total visits: 386 Total # of clients: 62 Av visits/client: 6.2 Range: 1 to 2 Total days: 79 Av visits/day: 4.9 Pt Townsend Total visits: 33 Total # of clients: 57 Av visits/client: 5.3 Range: 1 to 26 Total days: 83 Av visits/day: 3.7 Quilcene Total visits: 347 Total # of clients: 24 Av visits/client: 14.5 Range: 1 to 48 Total days: 69 Av visits/day: 5. Based on enrollment, 9% of Chimacum, 5% of Pt Townsend, and 14% of Quilcene 9-12 th grade students utilized SBHC mental health services during the 212-213 school year. 7 P a g e
Average # of Visits per Clinic Day Average # of Visits per Clinic Day Average # of Visits per Clinic Day 8. 7. 6. 5. 4. 3. 2. 1.. Chimacum Mental Health Visits by Month Winter break 212 213 Sept Oct Nov Dec Jan Feb March Apr May June Month Summer Break 8. 7. 6. 5. 4. 3. 2. 1.. Port Townsend Mental Health Visits by Month Winter break Summer Break Sept Oct Nov Dec Jan Feb March Apr May June 212 Month 213 8. 7. 6. 5. 4. 3. 2. 1.. Quilcene Mental Health Visits by Month Winter break 212 213 Sept Oct Nov Dec Jan Feb March Apr May June Month Summer Break 8 P a g e
Top Reasons for SBHC MH Visits: Chimacum Port Townsend Quilcene Student Stress Stress Stress Concern Family Family Court diversion Relationships Relationships Relationships School School Family Depression Anger -- % of total 86% 83% 1% Clinician Family Family Family Issue Relationships Relationships School Addressed School Self esteem Self esteem Mental health Stress Grief Self esteem Depression Stress % of total 7% 68% 78% self esteem grief anger alc/drug prevention future anxiety depression school relationships family stress Chimacum Top Visit Reasons (ranked by student concern) clinician addressed student concern 5 1 15 2 25 3 35 4 alc/drug prevention depression self esteem future anxiety anger school relationships family stress Port Townsend Top Visit Reasons (ranked by student concern) clinician addressed student concern 5 1 15 2 25 3 35 4 future mh anger grief self esteem school family relationships court diversion stress Quilcene Top Visit Reasons (ranked by student concern) clinician addressed student concern 5 1 15 2 25 3 35 4 At all three schools, the top student concern, by far, was stress and the top clinician addressed issue was family. Although students identified stress as the reason for their mental health visit, clinicians infrequently identified stress as the issue they addressed with the student because they actually identified and addressed a wide variety of other issues. 9 P a g e
# of Students # of Visits Individual Therapy Visits of Total: 1% 94% 95% 9% 85% 95% 86% The vast majority of visits are individual therapy 94% at Chimacum, 95% at Pt Townsend and 86% at Quilcene the remaining visits are for crisis intervention or contact/work with other agencies, family, or school staff. 8% Chimacum Pt Townsend Quilcene Referrals The most common referrals from the SBHC MH clinicians are for outpatient mental health services and for medical services at the SBHC. SBHC Mental Health Visits Over Time 1 9 8 7 6 5 4 3 2 1 Number of Individuals Served by MH Clinicians at SBHCs Over Time Sept-Dec 29 Chimacum Pt Townsend Quilcene Jan-June 21 Sept 21- June 211 Sept 211- June 212 Sept 212- June 213 6 5 4 3 2 1 Number of MH Visits at SBHCs Over Time Sept-Dec 29 Chimacum Pt Townsend Quilcene Jan-June 21 Sept 21- June 211 Sept 211- June 212 Sept 212- June 213 School Year School Year Compared to 29/1 when SBHC MH services began, the number of individuals and total visits have steadily increased over time. For Chimacum, the spike in 21-11 in number of individuals and visits is due to increased MH services in May/June 211 to help students cope after the suicide of a classmate. The total number of clients in 212-13 compared to 211-12 is up slightly in Chimacum, down slightly in Pt Townsend and similar in Quilcene. The total visits in 212-13 compared to 211-12 are up in Chimacum and Port Townsend and similar in Quilcene. Compared to the 29-1 school year, the number of individuals seen has increased over 1% and the number of visits has increased nearly 2%! 1 P a g e