The St. Mary's County Health Department (SMCHD) is the local health department for St. Mary's County, Maryland. SMCHD's Vision is to promote healthy choices, opportunities and environments for all who live, work and play in St. Mary's County.
SMCHD serves a population of 114,468 according to the U.S Census Bureau.
St. Mary's has been described as historically rural”, but has experienced a 31.7% increase in population since 2000. The demographics of the population are 77.5% White, 15.2% Black or African American, 5.7% Hispanic or Latino, 3.0% Asian, 0.5% American Indian, 0.1% Pacific Islander and 3.7% Two or More Races. The median household income in the county is $95,864. 5% of people within the county 65 or younger do not have health insurance and 3.6% of children are uninsured.
SMCHD's primary goal with this practice was to establish two School Based Health Centers (SBHCs) which deliver high quality medical care to the students and staff of St Mary's County Public Schools. The public health issue that this practice was designed to engage with is improving access to somatic and behavioral health care in two Health Professional Shortage Areas, (HPSA).
Spring Ridge Middle School (SRMS) is located in a HPSA for behavioral health and primary care while Margaret Brent Middle School (MBMS) is located in a HPSA for behavioral health care. This designation suggests students and staff have limited access to immunizations, chronic disease management, mental health services, and other primary care services. These barriers to care impact their attendance at school and outcomes for academic achievement.
The objectives of these two SBHCs are to increase access to care, decrease barriers to care, and improve student health and wellness. This will be measured by the number of SBHC appointments, patient evaluations, and improved academic outcomes. In addition, although the SBHCs are currently only at two locations, they are open to any teacher or student enrolled in St. Mary's County Public Schools and no student will be denied services for inability to pay.
Activities and dates:
1. SMCHD wrote and was awarded a Maryland Community Health Resources Commission (CHRC) grant for $650,000 to operationalize two new SBHC with the goal of promoting health equity and health care access (2020, awarded 2021)
2. Building the SBHC sites on each campus. (2021)
3. Expanding relationships between SMCPS and SMCHD. Building trust with school leadership and health services to establish SBHCs, gain their buy-in to assist with marketing and community awareness and SBHC utilization. (2021 and ongoing)
4. Policy and procedure writing (2021)
5. Recruiting and hiring for SBHCs (2021,22)
6. EHR build out, training (2021,22)
7. Payer enrollment, credentialing billing training for team (2022)
8. Training of staff on SBHC services both technical and processes (2021,22)
9. SBHCs opened in 2021, while schools were still doing virtual classes, to provide COVID-19 testing and vaccine access for the local community. During this time, SBHCs were also used for school required immunization clinics.
10. SBHCs opened fully for students and staff in August 2022.
Results and outcomes:
The largest public health impact of the SBHC's is that now two thousand students plus hundreds of staff have access to primary care and mental health services during the school day. This exponentially increases, after school hours, when we are able to provide services for any student or staff member of SMCPS. St. Mary's county has a 3.6% child uninsured rate which is higher than the average child uninsured rate in Maryland. In the 2019-20 school year SMCPS reported that 51 students were uninsured along with 49 others that were referred for insurance. The SBHCs provide services regardless of one's ability to pay. There is a sliding scale in place for those without insurance and payment plan options as well.
During the first three months of full operations, the SBHCs have completed over 183 visits as of 12/13, with the top visit types being sick visits, sports physicals and immunization appointments.
There has been a significant improvement in vaccine compliance at these schools, with SRMS and MBMS historically starting the school year with 80% compliance, when this year, both schools achieved 100% compliance by October 2022 with support of SBHC services.
Due to the still ongoing COVID-19 pandemic, these sites have also been utilized for community testing and mass vaccination efforts. The SBHCs initially prioritized telehealth appointments to connect and provide services to the community during the Covid-19 pandemic but currently have on-site patient visits. Telehealth visits are still vital in providing the community safe access to primary care and mental health services
In regards to community partnership, the St Mary's County Sheriff's Department, St Mary's County Health Department and St. Mary's County Public Schools came together to formalize the St. Mary's County Equity Task. This task force came about as the importance for collaboration across all sectors to better address equity overall was realized. SMCHD is the fiscal agent and lead for the operation of the two new School Based Health Centers (SBHCs). This support from the Equity Task Force allows SBHCs access to resources and expertise of SMCPS and SMCSO to help clients reach their goals.
Additional community partnerships in this effort are with St. Mary's County Public Library who provides an onsite library for staff and students. Collaboration with University of Maryland Extension has provided nutritional education support. Collaboration with the Health Promotions team and Behavioral Health teams at SMCHD allow us to bring their programs to staff and students onsite at the SBHCs. These programs include Asthma Treatment program, Smoking Cessation, Suicide Prevention, Youth Mentoring and many others. SBHC teams continue to work closely with the SMCPS Health Services team to identify unmet health and socioeconomic needs of SMCPS students that can be addressed through the comprehensive resources offered at the SBHCs. Additional partnership and advocacy support has been received from the St Mary's Board of Education, St Mary's County Commissioners, and State legislature.