Utilizing School Health Clinics to Advance Health Care Transition
Your time as a caterpillar has expired. Your wings are ready.
Children’s Special Health Care Services Division
Michigan Department of Health and Human services
If only the transition from adolescence to adulthood was as clear cut as that of a caterpillar to a butterfly. While the importance of health care transition has grown in recognition, data tells us there is room to improve the systems surrounding transition. Thanks to a replication grant from the Association of Maternal & Child Health Programs, the State of Michigan’s Children’s Special Health Care Services (CSHCS) replicated a Got Transition model to implement transition services within a school-based clinic.
The Michigan Department of Health and Human Services (MDHHS) has a well-defined network of 100 Child and Adolescent Health Care (CAHC) programs located throughout the state. These programs, staffed with mid-level practitioners, social workers and medical professionals, deliver a range of services, focusing on primary, preventive, and early intervention health care services, provided either on school property or nearby in adjacent locations. These centers make accessing health care easy for students living in underserved areas. School clinic staff work collaboratively with students, parents, school personnel, and the local health and human service community to assure students have what they need to be healthy and successful. Health education and personal responsibility are cornerstones of the services delivered, as clinic staff, families, and educators work to engage students in their own health maintenance.
Utilizing this well-established network, Michigan’s CSHCS devised a pilot project to replicate Got Transition’s “Using the Six Core Elements of Health Care Transition in Medicaid Managed Care.” The project’s goal is to assist adolescents – both those with special health care needs and those without – in developing needed skills to make health care transitions from pediatric to adult providers, using the Six Core Elements of Health Care Transition framework.
In Michigan, only 15.2 percent of youth without special health care needs and 16.7 percent of youth with special health care needs receive the services necessary for transition to adult health care (Data Resource Center for Child & Adolescent Health, 2016-2017). In 2014, Got Transition reported that transition planning is associated with a reduction in medical complications, increased adherence to care, more satisfactory patient experience, improved continuity of care, better patient-reported outcomes, and reduced cost.
The Health Department of Northwest Michigan and its school-based clinic, Blue Devil Wellness Center, partnered with CSHCS on this project. The clinic serves approximately 990 high school students at Gaylord High School. A team was formed to lead the project, customize documents, review the online Transition to Adulthood course, and develop processes for integrating transition into existing clinic protocols. The clinic’s Youth Advisory Council reviewed the documents and plans for implementation and provided feedback. The customized documents, online Transition to Adulthood course, and processes were implemented in February.
The project focused primarily on junior and senior students. A comprehensive evaluation strategy that included student and clinic staff surveys, key informant interviews, post assessment of clinic readiness, and evaluation of transition readiness assessments was implemented in May.
Several key lessons were learned throughout the project. Specifically, students from this school perceive themselves to be financially independent: 75 percent “disagreed” or “strongly disagreed” that they received financial help with school or work. This presented a potential opportunity to impact the population with financial management education.
Evaluation of transition readiness assessments indicated an independent population with regards to health-related issues but highlighted the need for additional information about health insurance, including how to obtain it, what it covers, and why it is important. Student feedback emphasized the importance of keeping all correspondence and education concise, specifically suggesting the online Transition to Adulthood course be shortened.
That feedback prompted lots of reflection by staff, including:
Amanda Rothfuss, Blue Devil Wellness Center social worker: “The biggest change I would suggest would be starting the process early in the school year. After Christmas break, we face inclement weather and, if not snow, then spring fever begins to set in, especially in seniors.”
Carrie Miller, Blue Devil Wellness Center nurse practitioner: “I would recommend other clinics review existing handouts and consider integrating transition information. Existing handouts are often already part of the clinic process and integrating transition language helps to make delivery of the information consistent and easy for clinicians.”
Betty Steffes, medical assistant for the Blue Devil Wellness Center: “I think this is very important information for students in our school. I would recommend varying the ages of students reached because some of the freshmen in our school are handling their own medical care already – this information could be helpful to them.”
Clinic staff also recommended creating a transition infomercial that can run on the lobby television, reaching all clinic patients.
From a systems standpoint, the Blue Devil Wellness Center demonstrated a 36 percent improvement on its post-clinic assessment compared to its pre-clinic assessment. This improvement was demonstrated in six months. Significant gains were made in the area of policy and incorporating youth feedback. In addition to improved transition readiness from the clinic’s perspective, 38 students responded to a survey following the project. Of responding students, 89 percent reported learning something new during the transition process and 89 percent reported understanding that transition to an adult provider is important.
Outcomes from this pilot project were demonstrated in a short period of time. This indicates great promise for advancing health care transition utilizing school-based health centers. Moving forward, CSHCS will create a toolkit to be made available to CAHC school-wellness program centers across the state. (With approximately 100 clinics, the CAHC program reaches more than 36,000 students statewide.)
In addition, CSHCS will create a learning collaborative to continue to expand this program. The collaborative will consist of five to 10 school clinics. CSHCS will facilitate pre- and post-clinic assessments, provide technical assistance, and create surveys for administration among the student population. This learning collaborative will inform future collaboratives to extend the transition program across the state.